Nursing Diagnosis for Cardiovascular Diseases

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and include:

• Coronary heart disease – disease of the blood vessels supplying the heart muscle
• Cerebrovascular disease – disease of the blood vessels supplying the brain
• Peripheral arterial disease – disease of blood vessels supplying the arms and legs
• Rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
• Congenital heart disease – malformations of heart structure existing at birth.
• Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.

FACTS ABOUT CARDIOVASCULAR DISEASES

• CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause;
• An estimated 17.5 million people died from CVDs in 2005, representing 30% of all global deaths. Of these deaths, an estimated 7.6 million were due to coronary heart disease and 5.7 million were due to stroke.
• Over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women;
• By 2015, almost 20 million people will die from CVDs, mainly from heart disease and stroke. These are projected to remain the single leading causes of death.

CAUSES OF CARDIOVASCULAR DISEASES

• The causes of CVDs are well established and well known. The most important causes of heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. These are called ‘modifiable risk factors’.
• The effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity; these are called ‘intermediate risk factors’.
• The major modifiable risk factors are responsible for about 80% of coronary heart disease and cerebrovascular disease.
• There are also a number of underlying determinants of chronic diseases, or, if you like, "the causes of the causes". These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, and population ageing. Other determinants of CVDs are poverty and stress.

COMMON SYMPTOMS OF CARDIOVASCULAR DISEASES

• Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease.
• Symptoms of a heart attack include: pain or discomfort in the centre of the chest; pain or discomfort in the arms, the left shoulder, elbows, jaw, or back. In addition the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale.
• Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
• The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include sudden onset of: numbness of the face, arm, or leg, especially on one side of the body; confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; and fainting or unconsciousness.
• People experiencing these symptoms should seek medical care immediately.

POTENTIAL NURSING DIAGNOSIS FOR SEVERE HYPERTENSION:

1. Risk for decreased cardiac output
2. Activity intolerance
3. Acute headache pain
4. Imbalanced nutrition more than body requirements
5. Ineffective coping
6. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

VIEW SAMPLE NURSING CARE PLAN FOR HYPERTENSION

POTENTIAL NURSING DIAGNOSIS FOR CHRONIC HEART FAILURE (CHF) 

1. Decreased Cardiac output
2. Activity intolerance
3. Excess fluid volume
4. Risk for impaired gas exchange
5. Risk for impaired skin integrity
6. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

VIEW SAMPLE NURSING CARE PLAN FOR CHRONIC HEART FAILURE (CHF)

POTENTIAL NURSING DIAGNOSIS FOR ANGINA (CORONARY ARTERY DISEASE)

1. Acute pain
2. Risk for decreased cardiac output
3. Anxiety
4. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR MYOCARDIAL INFARCTION

1. Acute pain
2. Activity intolerance
3. Anxiety/ Fear
4. Risk for decreased cardiac output
5. Ineffective tissue perfusion
6. Risk for excess fluid volume
7. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR DYSRHYTHMIAS (INCLUDING DIGITALIS TOXICITY)

1. Risk for decreased cardiac output
2. Risk for poisoning, digitalis toxicity
3. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR CARDIAC SURGERY: POSTOPERATIVE CARE – CORONARY ARTERY BYPASS GRAFT (CABG), MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB), CARDIOMYOPLASTY, VALVE REPLACEMENT

1. Risk for decreased cardiac output
2. Acute pain
3. Ineffective role performance
4. Risk for ineffective breathing pattern
5. Impaired skin integrity
6. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR THROMBOPHLEBITIS: DEEP VEIN THROMBOSIS(INCLUDING PULONARY EMBOLI CONSIDERATIONS)

1. Ineffective tissue perfusion
2. Acute pain
3. Impaired gas exchange (in presence of pulmonary embolus)
4. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care, and discharge needs

Source:

• WHO (World Health Organization)
• Lippincott Review Series