Assessment Signs and Symptoms decreased cardiac out put syncope lightheaded ness dizziness fatigue chest discomfort

palpitations

Diagnosis 1.Decreased Cardiac Output related to altered heart rhythm as evidenced by palpitations

Planning To be able to maintain cardiac output

1. 2.

3.

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5. 2. Anxiety related to fear of the unknown as evidenced by tension, apprehension and expressed concerns To be able to reduced the anxiety of the patient regarding illness 1. 2. 3. 4.

Intervention determine baseline data monitor cardiac rhythm continuously to note effectiveness of medications and or devices administer supplemental oxygen as indicated to increase oxygen available to tissues. Promote adequate rest by decreasing stimuli and providing quiet environment assist with or perform self-care activities for client Establish a therapeutic relationship Be available to client for listening and talking Encourage patient to acknowledge and express feelings Provide comfort measures like calm

Evaluation The client will : - demonstrate increase heart rate, blood pressure, respiratory rate, level of consciousness within normal ranges. - display hemodynamic stability - report or demonstrate decreased episodes of fatigue and discomfort

The client will: - identify and express feelings freely and effectively - look forward and plan for the future one day at a time - expresses feelings of confidence in ability to take appropriate actions in an

5. 3. Deficient Knowledge regarding medical condition related to lack of information as evidenced by questions and statements of misconception To be able to express understanding of condition/ diseases process and treatment 1. 2. 3.

4. 5. 4. Risk for activity intolerance related to imbalance between myocardial oxygen supply and demand To be able to verbalize understanding of potential loss of ability I relation to existing condition 1. 2.

3.

and quiet environment Acknowledge anxiety or fear. Ascertain level of knowledge, including anticipatory needs. Determine clients ability to learn Assess the level of clients capabilities and possibilities of the situation determines the clients most urgent needs discuss clients perception of needs determine baseline activity and level of physical condition implement physical therapy and exercise program in conjunction with the client and other team members promote/implement conditioning program and support inclusion in exercise to prevent deterioration

emergency

The patient will : - participate in the learning process - identify interferences to learning specific action to deal with them

The patient will : - participate in conditioning program to enhance ability to perform

4. Provide information regarding potential interferences 5. assist client with planning for changes that may become necessary 5. Risk for poisoning related to range of limited therapeutic effectiveness To be able to identify hazards that could lead to accidental poisoning 1.determine presence of internal or external risk factors in clients environment 2. assess clients knowledge of safety hazards of drugs 3. Encourage discarding of outdated unused drugs 4. Review drug side effects/ potential interaction with client 5. Stress importance of supervising individual with cognitive limitation The patient will : - verbalize feelings and standing of dangers of poisoning - identify hazards that could lead to accidental poisoning - correct environmental hazards

MANAGEMENT : Based on the cause of atrioventricular block the stability of the patient treatment is directed toward increasing the heart rate to maintain normal cardiac output. If the patient is stable and has no symptoms, NO TREATMENT is indicated other than decreasing or eradicating the cause. IV bolus of atropine is the initial treatment of choice if patient is short of breath, complaints of chest pain or lightheadedness or has low blood pressure. If the patient has myocardial infarction, transcutaneous pacing should be started. If heart block persist a permanent pacemaker is necessary.