ASSESSMENT Subjective: “madalas ako mahilo”, as verbalized by the patient.

Objective: >lethargic >decreased cardiac output >decreased stroke volume >increased peripheral vascular resistance >VS taken as follows: T: 37.2 PR: 83 RR: 18 BP: 180/100

DIAGNOSIS Decreased Cardiac Output r/t malignant hypertension as manifested by decreased stroke volume.

PLANNING STG: After 6 hrs of nursing interventions, the client will have no elevation in blood pressure above normal limits and will maintain blood pressure within acceptable limits. LTG: After 5 days of nursing interventions, the client will maintain adequate cardiac output and cardiac index.

INTERVENTION 1.monitor BP every 1-2 hours, or every 5 minutes during actve titration of vasoactive drugs. 2. monitor ECG for dysrrhythmias, conduction defects and for heart rate.

RATIONALE

EVALUATION STG: After 6 hrs of nursing interventions, the client had no elevation in blood pressure above normal limits and will maintain blood pressure within acceptable limits. Goal was met. LTG: After 5 days of nursing interventions, the client maintained an adequate cardiac output and cardiac index. Goal was met.

1. changes in BP may indicates changes in patient status requiring prompt attention. 2. decrease in cardiac output may result in changes in cardiac perfusion causing dysrhythmias. 3. suggest frequent 3. it may decreases position changes. peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing. 4.encourage patient 4. caffeine is a to decrease intake of cardiac stimulant caffeine, cola and and may adversely chocolates. affect cardiac function. 5. observe skin 5. peripheral color, temperature, vasoconstriction capillary refill time may result in pale, and diaphoresis. cool, clammy skin, with prolonged capillary refill time

6.auscultate heart tones.

7. administer medicines as prescribed by the physician. 8. instruct client & family on fluid and diet requirements and restrictions of sodium.

due to cardiac dysfunction and decreased cardiac output. 6. hypertensive patients often have S4 gallops caused by atrial hypertrophy. 7. to promote wellness.

8. restrictions can assist with decrease in fluid retention and hypertension, thereby improving cardiac output. 9. instruct client and 9. promotes family on knowledge and medications, side compliance with effects, drug regimen. contraindications and signs to report.

ASSESSMENT Subjective: “ Laging sumasakit ang aking ulo at parang nanlalabo ang aking paningin”, as verbalized by the patient. Objective:  Tachycardia  Shortness of breath  >rales  Restlessness  Cool, clammy skin  Optic disc papilledema  Increased blood pressure.

DIAGNOSIS Ineffective Tissue Perfusion: Cardiopulmonary, Gastrointestinal and Peripheral r/t hypertension and decreased cardiac output as manifested by blurred vision and increased blood pressure..

PLANNING STG: After 8 hrs of nursing interventions, blood pressure will be within set parameters for the client. LTG: After 6 days of nursing interventions, the client will have an adequate tissue perfusion to his body systems.

INTERVENTION 1. monitor VS at least q 1-2 hrs and prn.. 2. encourage patient to decrease intake of caffeine, cola and chocolates. .3. administer vasoactive drugs and titrate as ordered to maintain pressures at set parameters for patient. 4. observe for complaints of blurred vision, tinnitus or confusion. 5. monitor I&O status.

RATIONALE 1.to monitor baseline data. 2. caffeine is a cardiac stimulant and may adversely affect cardiac function. 3. these frugs have rapid action and may decrease the blood pressure too rapidly, resulting in complications. 4. may indicate cyanide toxicity from increasing intracranial pressure. 5. I&O will give an indication of fluic balance or imbalance, thus allowing for changes in treatment regimen when required.

EVALUATION STG: After 8 hrs of nursing interventions, blood pressure maintained within set parameters for the client. Goal was met. LTG: After 6 days of nursing interventions, the client had an adequate tissue perfusion to his body systems. Goal was met.

6. monitor for sudden onset of chest pain. 7. monitor ECG for changes in rate, rhythm, dysrhythmias and conduction defects. 8. observe extremities for swelling, erythema, tenderness and pain. Observe for decreased peripheral pulses, pallor, coldness and cyanosis.

6. may indicate dissecting aortic aneurysm. 7. decreased perfusion may result in dysrhythmias caused by decrease in oxygen. 8.Bedrest promotes venous statis which can increase the risk of thromboembolus formation. If treatment is too rapid and aggressive in decreasing the blood pressire, tissue perfusion will be impaired and ischemia can result. 9. promotes knowledge and compliance with treatment. Promotes prompt detection and facilitates prompt intervention.

9. instruct client in signs/symptoms to report to physician such as headache upon rising, increased blood pressure, chest pain, shortness of breath, increased heart rate,

visual changes, edema, muscle cramps and nausea and vomiting.

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