ASSESSMENT : NUTRITION

• How often the patient self-monitors BP, blood glucose

and weight as appropriate to the medical diagnoses.
• What the patient normally eats and drinks in a typical
day and any food preferences (including cultural or
ethnic preferences).
 ASSESSMENT : NUTRITION

• Eating habits (tinned or commercially

prepared foods vs. fresh foods,
restaurant cooking vs. home cooking,
assessing for high-sodium foods, dietary
intake of fats).
 ASSESSMENT: ELIMINATION

• Nocturia
(common in patients with HF)
Fluid collected in the dependent tissues (extremities)
during the day redistributes into the circulatory system
once the patient is recumbent at night.
* Patients may be taught to modify (titrate) their dose of
diuretics (e.g. frusemide) on the basis of urinary pattern,
daily weight and symptoms of dyspnoea.
 ASSESSMENT: ACTIVITY AND EXERCISE

• Activity intolerance
• New symptoms or a change in the usual angina or
angina equivalent during activity
• Exercise
• intensity of exercise
• how long or how often patient exercise
• fatigue associated with low ejection fraction
 ASSESSMENT: SLEEP AND REST

• Changes in sleep pattern

• awakening with shortness of breath
• awakening with angina
(all indicative of worsening HF)
 ASSESSMENT :COGNITION AND
PERCEPTION

• short-term memory intact

• history of dementia, depression
• anxiety
• hearing/ visual impairment
(patients with HF may not be able to weigh themselves independently, nor keep
records of weight, BP, pulse or other data requested by the healthcare team)
 ASSESSMENT : SELF-PERCEPTION
AND SELF-CONCEPT
• Chronic cardiac illness, such as HF, or experiencing an acute cardiac
event, such as an Ml, can alter an individual's self-perception and self-
concept.
• Understand that patients' beliefs and feelings about their health
(cardiac reactivity)
 A SSESSMENT : SELF - P ER CEP T IO N A N D SELF - CO N CE P T

• Personality y trait: Type A behavior

• characterized by competitive, hard-driving activity and a sense of time
urgency
• react to frustrating situations with an increase in BP, heart rate and neuroen-
· docrine responses
 ASSESSMENT : ROLES AND RELATIONSHIPS

• Determining the patient's social support systems

• Hospital stay shortened
• Assesses for any significant effects the cardiac illness has had on the
patient's role in the family.
 A SSESSMENT : SEXUA LIT Y A ND R EP RO DUCT IO N

• Recovering from cardiac illnesses or procedures are concerned about

sexual activity
• Women
• Reproductive history must be obtained with serious cardiac
condition
• reproductive history includes information about previous
pregnancies, plans for future pregnancies, oral contraceptive use
(especially in women older than 35 years who are smokers)
 ASSESSMENT : COPING AND STRESS TOLERANCE

• Anxiety, depression and stress : influence both the development of and

recovery from CAD.
• Depression : risk for MI and heart disease related death
• Stress : increased circulation of catecholamines and cortisol, and has
been strongly linked to cardiovascular events
 DIAGN O ST IC P RO CED UR E S : LA BO R ATO RY T EST S

Purposes:
• To assist in diagnosing an AMI (angina pectoris, chest pain resulting from an insufficient supply of
blood to the heart, cannot be confirmed by either blood or urine studies)
• To identify abnormalities in the blood that affect the prognosis of a patient with a cardiac
condition
• To assess the degree of inflammation
• To screen for risk factors associated with atherosclerotic CAD
• To screen generally for abnormalities.
 DIAGNOSTIC PROCEDURES :LABORATORY TEST

• Cardiac enzymes
• Biochemical markers are particularly important to help diagnose acute coronary
syndromes
• Myocardial necrosis
• presence of proteins in the blood from the damaged myocytes: cardiac troponin T, cardiac
troponin I, creatine kinase and lactate dehydrogenase.
• can be detected w/in 4 hours of ischemic injury, peaks at around 24 hours and remains
elevated for up to 14 days
 DIAGN O ST IC P RO CED UR E S : LA BO R ATO RY T EST

• Blood chemistry, hematology and coagulation studies

• Serum electrolyte levels : Na, K, Mg, Ca
Laboratory Test Implications
Blood Chemistry Hyponatraemia: fluid excess and can be caused by heart
1. Sodium ( Na) failure
135-145 mmol/L Hypenatremia : decreased water intake or loss of water
through excessive sweating or diarrhoea.

2. Potassium (K'") -has a major role in cardiac activity

3.6-5.0 mmol/L Hypokalaemia: Decreased (K+) causes arrthythmia;
ventricular tachycardia or ventricular fibrillation; digoxin
toxicity
Hyperkalaemia: heart block, asystole and life-threatening
ventricular arrhythmias.
Laboratory Implications
Test
3. Calcium (Ca++) blood coagulability, neuromuscular activity and automaticity of the nodal cells
(sinus and atrioventricular nodes)
Hypocalcemia : impair myocardial contractility, risk for HF
Hypercalcemia: potentiates digoxin toxicity, causes increased myocardial
contractility; ventricular fibrillation.

4. Magnesium absorption of calcium, protein and carbohydrate synthesis ,

(Mg++) 0.8-1.0 muscular contraction.
mmol/L Hypomagnesemia: predispose patients to atrial or ventricular
tachycardia
Hypermagnesemia: depress contractility and excitability of the
myocardium; asystole
Laboratory Test Implications
Serum Urea End products of protein metabolism excreted
3.0-8.0 mmol/L by the kidneys.
Elevated reflects reduced renal perfusion
from decreased cardiac output or intravascular
fluid volume deficit as a result of diuretic
therapy or dehydration.

Creatinine Elevated : renal impairment results to decrease

0.06-0.12 mmol/L cardiac output.
Laboratory Test
Coagulation Studies
Partial thromboplastin (PTT)
60-70 s
Activated partial
thromboplastin time (aPTT)
20-39 s
Prothrombin time (PT) 11-
15 s
Implications
Implications
Activity of the intrinsic pathway ; assess the effects
of unfractionated heparin.
A time therapeutic range is 1.5-2.5 times baseline
values; Adjustment of heparin dose is required for a
PTT, 50 s (I dose) or 100 s (-l, dose).
PT measures the extrinsic pathway activity and is
used to monitor the level of anticoagulation with
warfarin.
Laboratory Test Implications
C- reactive protein is a venous blood test that
<3 mg/dl measures levels of CRP, a protein
produced by the liver in response
to systemic inflammation
* CVD risk ( atherosclerosis)