CARDIAC ARREST

- It is a condition in which the heart suddenly and unexpectedly stop beating and the cessation of
blood flow occurs towards the brain and other vital organs.
ETIOLOGY
 Ventricular diseases- causes the abnormal breathing of the ventricles
 Coronary artery disease (CAD)- In the case of CAD, there will be a reduction of blood supply to the
muscles because of the partial or complete block of blood vessels.
 Severe physical stress- causes the abnormalities in the conuction system of the heart.
 Structural abnormalities- these all are another reason for the development of cardiac arrest. During
cardiomyopathy and some heart infections abnormal spreading of electric activity will occur, which
leads to cardiac arrest.
1. SUBJECTIVE DATA
NURSING HISTORY

2. OBJECTIVE DATA
 Physical Assessment
 Absence of pulse
 Unconsciousness/ unresponsiveness
 No respiratory movements
 No blood pressure
 Pupils begin dilating within 45 secs
 Lips and nail beds turn blue and skin turns pale
 DIAGNOSTIC ASSESSMENT
a. Non-invasive
ELECTROCARDIOGRAPHY
o Records the electrical activity of the heart including the timing and
duration of each electrical phase in your heartbeat.
o RESULT: Ventricular fibrillation. There is a complete absence of
properly formed QRS complexes and no obvious P waves.
Recent onset of arrhythmia is suggested by the coarse
morphology of the fibrillatory waves
HOLTER MONITORING
o Records the electrical activity of the heart during daily activities
o a small, wearable device that records the heart's rhythm. It's used
to detect or determine the risk of irregular heartbeats
(arrhythmias).
 EXERCISE/ STRESS TEST-
o to determine how well your heart responds during times when it’s
working its hardest. During the test, you’ll be asked to exercise —
typically on a treadmill — while you’re hooked up to
an electrocardiogram (EKG) machine
o An exercise stress test is primarily used to help your doctor
determine if your heart receives enough oxygen and proper blood
flow when it needs it most, such as when you are exercising.
ECHOCARDIOGRAPHY-
o checks how your heart's chambers and valves are pumping blood
through your heart. An echocardiogram uses electrodes to check
your heart rhythm and ultrasound technology to see how blood
moves through your heart.
o RESULT: Features noted were the presence or absence of
cardiac motion, ventricular function quality, right ventricular
dilation or pericardial fluid.
MRI- STUDIES
o Cardiac MRI helps your doctor detect or monitor cardiac disease
by: evaluating the anatomy and function of the heart chambers,
heart valves, size of and blood flow through major vessels, and
the surrounding structures such as the pericardium (the sac that
surrounds the heart).
o Cardiac MRI helps your doctor detect or monitor cardiac disease
by: evaluating the anatomy and function of the heart chambers,
heart valves, size of and blood flow through major vessels, and
the surrounding structures such as the pericardium (the sac that
surrounds the heart).
INVASIVE

CARDIAC CATHETERIZATION
 o procedure in which a thin, flexible tube (catheter) is guided through a
blood vessel to the heart to diagnose or treat certain heart conditions,
such as clogged arteries or irregular heartbeats.

BLOOD STUDIES
o A sample of your blood might be tested to check the levels of
potassium, magnesium, hormones and other chemicals that can affect
your heart's ability to function. These include the examination of
cardiac enzyme level, serum electrolytes level and hormonal level.
Troponin blood test 
o troponin is a protein which is released into the blood stream when the
heart muscle is damaged. The troponin level provides a quick and
accurate measure of any heart muscle damage. It's used to help in
the assessment following suspected heart attack

NURSING DIAGNOSIS
 DECREASED CARDIAC OUTPUT R/T CARDIAC ARREST, DYSRYTHMIA.
 Assess vital signs, CVP, urinary output, and peripheral pulses
 Assess heart rate and rhythm (ECG)
 Oxygen admministration as hypoxia can lead to further dysrhythmias.
 Administer drugs, antidysrythmic medication as ordered.
 Administer fluid therapy as ordered.
 IMPAIRED TISSUE PERFUSION R/T DECRAESED CARDIAC OUTPUT
 Note the color and temperature of the skin.
 Monitor peripheral pulses.
 Monitor urine output.
 Provide warm environment.

C. PLANNING FOR HEALTH RESTORATION AND MAINTENANCE

Maintain a healthy weight- Weight gain is linked to increased blood cholesterol, blood pressure
and risk for diabetes
 Do not smoke. Chemicals in cigarette smoke cause the blood to thicken and form clots inside
veins and arteries, which causes damage.
Eat a healthy food. A study found that a diet high in added fats, fried foods, processed meats,
and sugary drinks was associated with a greater risk of sudden cardiac death, while
Mediterranean diet was associated with a lower risk. The findings provide evidence that
adopting a healthier diet may decrease the risk of sudden cardiac death. A heart-healthy diet
also includes plenty of vegetables, fruits, and whole grains. Research shows that the
Mediterranean diet—full of fruits, vegetables, fish, cereals, and legumes, with little meat and
dairy—may reduce the risk of heart disease
Increase physical activity and exercise. Being physically active is a major step toward good
heart health. It's one of your most effective tools for strengthening the heart muscle, keeping
your weight under control and warding off the artery damage from high cholesterol, high blood
sugar and high blood pressure that can lead to heart attack or stroke.
Get enough sleeps. Sleep provides time for the body to restore and recharge, playing a key
role in nearly all aspects of physical health. For the cardiovascular system, insufficient or
fragmented sleep can contribute to problems with blood pressure and heighten the risk of heart
disease, heart attacks, diabetes, and stroke. Poor sleep, whether from a lack of sleep or sleep
disruptions, is associated with non-dipping, meaning that a person’s blood pressure doesn’t go
down at night. Studies have found that elevated nighttime blood pressure is tied to overall
hypertension (high blood pressure).

Be careful with pain killers. According to Dr. Daniel Simon, chief of cardiology at University
Hospitals Case Medical Center in Cleveland, painkillers can cause respiratory arrest and low
blood oxygen can trigger a deadly heart rhythm known as ventricular fibrillation in which the
heart quivers but does not circulate blood. Cleveland Clinic cardiologist Dr. Bruce Lindsay, past
president of the Heart Rhythm Society, said the two drugs in combination could cause
respiratory arrest.

“As with any of these painkillers, if you get too much on board, it really depresses the central nervous
system so the patient could lapse into a deep sleep or even a coma. And if their respiratory capacity was
too depressed, they would just stop breathing. If they stop breathing, eventually of course the heart will go
into cardiac arrest, but not because of some primary heart problem. It is simply because the final mode of
death is that the heart stops beating.”

D. IMPLEMENTATION

1. MEDICAL/SURGICAL MANAGEMENT

Medical Mngt.

 Oxygen Therapy
  CPR. To restore partial flow of oxygenated blood to the brain and heart who are not
breathing and pulses.
Objective: To delay tissue death and exted the brief window of opportunity for a successful
resuscitation without permanent damage.
 Defibrillation. Generally includes delivery of an electrical shock through the chest wall to
the heart. The procedure, called defibrillation, momentarily stops the heart and the chaotic
rhythm. This often allows the normal heart rhythm to resume.

SURGICAL MANAGEMENT
 Coronary artery bypass surgery. This procedure involves sewing veins or arteries in place
at a site beyond a blocked or narrowed coronary artery, restoring blood flow to your heart.
This can improve the blood supply to your heart and reduce the frequency of racing
heartbeats.
 Coronary Angioplasty. This procedure opens blocked coronary arteries, letting blood flow
more freely to your heart, which might reduce your risk of serious arrhythmia. A long, thin
tube is passed through an artery, usually in your leg, to a blocked artery in your heart. This
catheter is equipped with a special balloon tip that briefly inflates to open the blocked
artery.
 Corrective heart surgery. If you have a congenital heart deformity, a faulty valve or
diseased heart muscle tissue due to cardiomyopathy, surgery to correct the abnormality
might improve your heart rate and blood flow, reducing your risk of fatal arrhythmias.

PHARMACOLOGIC
ACE INHIBITORS- (‘PRIL”)
o heart medications that widen, or dilate, your blood vessels. That increases the amount of
blood your heart pumps and lowers blood pressure. They also raise blood flow, which
helps to lower your heart's workload
BETA BLOCKERS- (:OLOL”)
o lower stress on the heart and blood vessels
o These studies not only suggest that beta-blockade could reduce myocardial oxygen
requirements and the number of shocks necessary for defibrillation, but also improve
postresuscitation myocardial function, diminish arrhythmia recurrences and prolong
survival.

CALCIUM CHANNEL BLOCKERS (:DIPINE)-

o Calcium channel blockers are medications used to lower blood pressure. They work by
preventing calcium from entering the cells of the heart and arteries. Calcium causes the
heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium
channel blockers allow blood vessels to relax and open

ANTIARRYTHMIC DRUGS
COMPLIMENTARY & ALTERNATIVE MEDICINES
Magnesium
o Magnesium is a key element in heart health. It has a role in maintaining normal heart
rhythm and is often used to treat irregular heartbeat (arrhythmia). 

Alternative Medicine
Uncaria rhynchophylla (Cat’s Claw)
o traditional Chinese medicine to treat hypertension by dilating the blood vessels.
o help relax the smooth muscles (such as the intestines), and act as a diuretic (helping the
body eliminate excess water)

Veratrum alkaloids
o enhance nerve and muscle excitability by increasing sodium ion conductivity.

Crataegus (Hawthorn berry)

o Crataegus extract antagonizes the increases in cholesterol, triglyceride, and phospholipid
levels in low-density lipoprotein (LDL) and very low-density lipoprotein in rats fed a
hyperlipidemic diet; thus, it may inhibit the progression of atherosclerosis.
 Allium sativum (garlic) (4-5 cloves)
o Prevents atherosclerosis
o A number of studies have demonstrated these effects that include lowering blood
pressure, inhibiting platelet aggregation, enhancing fibrinolytic activity, reducing serum
cholesterol and triglyceride levels, and protecting the elastic properties of the aorta.
Xin Bao
o stimulates and increased excitability of the sinuatrial node.

NUTRITIONAL & DIET THERAPY

Foods to limit:
Sodium
Too much sodium may encourage the buildup of fluids around your lungs, increase your blood pressure,
and put stress on your heart.
Water and other fluids
Too much fluid after a heart attack can make your heart work harder than it should. It can also cause poor
appetite and shortness of breath. Your doctor will let you know how much fluid you need to aim for a day.
Caffeine
After a heart attack, your heart needs lots of rest. Avoid excessive stimulation from caffeine by limiting how
much coffee, black tea, and soda you drink.
DIET THERAPY
CLIENT EDUCATION
Maintain a healthy weight- Weight gain is linked to increased blood cholesterol, blood pressure
and risk for diabetes
Do not smoke or use tobacco. Chemicals in tobacco can damage the heart and blood vessels.
Cigarette smoke reduces the oxygen in the blood, which increases blood pressure and heart
rate because the heart has to work harder to supply enough oxygen to the body and brain.
Eat a healthy food. A study found that a diet high in added fats, fried foods, processed meats,
and sugary drinks was associated with a greater risk of sudden cardiac death, while
Mediterranean diet was associated with a lower risk. The findings provide evidence that
adopting a healthier diet may decrease the risk of sudden cardiac death. A heart-healthy diet
also includes plenty of vegetables, fruits, and whole grains. Research shows that the
Mediterranean diet—full of fruits, vegetables, fish, cereals, and legumes, with little meat and
dairy—may reduce the risk of heart disease
Get moving: Aim for at least 30-60 minutes of activity daily. Physical activity helps control your
weight. It also reduces the chances of developing other conditions that may put a strain on the
heart, such as high blood pressure, high cholesterol and type 2 diabetes. It's one of your most
effective tools for strengthening the heart muscle, keeping your weight under control and
warding off the artery damage from high cholesterol, high blood sugar and high blood pressure
that can lead to heart attack or stroke.
Get enough sleeps. Sleep provides time for the body to restore and recharge, playing a key
role in nearly all aspects of physical health. For the cardiovascular system, insufficient or
fragmented sleep can contribute to problems with blood pressure and heighten the risk of heart
disease, heart attacks, diabetes, and stroke. Poor sleep, whether from a lack of sleep or sleep
disruptions, is associated with non-dipping, meaning that a person’s blood pressure doesn’t go
down at night. Studies have found that elevated nighttime blood pressure is tied to overall
hypertension (high blood pressure).

Be careful with pain killers. According to Dr. Daniel Simon, chief of cardiology at University
Hospitals Case Medical Center in Cleveland, painkillers can cause respiratory arrest and low
blood oxygen can trigger a deadly heart rhythm known as ventricular fibrillation in which the
heart quivers but does not circulate blood. Cleveland Clinic cardiologist Dr. Bruce Lindsay, past
president of the Heart Rhythm Society, said the two drugs in combination could cause
respiratory arrest.
Manage Stress
o Some people cope with stress in unhealthy ways — such as overeating, drinking or
smoking. Finding alternative ways to manage stress — such as physical activity, relaxation
exercises or meditation — can help improve your health.
Get regular health screenings
o help in early detection and prevention of complications and avert any resultant heart
damage.

EVALUATION