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This Concept Map, created with IHMC CmapTools, has information related to: Heart Health Concept Map, Key Problem #5- Unable to cope with stress in a positive way Nursing Diagnoses- Ineffective coping related to perceived stress of current illness as evidenced by patient stating, "I just can't do this . . . I wish I never even came here." Assessment Data: Poor coping habits- smoking and eating Negative attitude Lack of self confidence Little ambition to achieve goals Patient stating, "I just can't do this . . . I wish I never even came here." Short-term goal: Patient will be able to state two effective ways to cope with stress by the end of the fourth cardiac rehab session. Long-term goal: Patient will be able to incorporate two positive coping skills into her life within two months. Interventions: 1. Assess how the patient copes with stress currently (AHA, 2012a). 2. Educate the patient about stress management strategies such as staying organized, managing time well, exercising, getting 6-8 hours of sleep each night, taking one step at a time, not worrying about what you cannot change, laughing about something everyday, making time to do things you enjoy, and increasing your self-worth by accomplishing a task or helping others (AHA, 2011). 3. Assist the patient in finding appropriate ways to manage and reduce stress in her own life (AHA, 2012a). 4. Instruct the patient on how to use positive self-talk to change her negative emotions into more positive ones (AHA, 2013a). 5. Assist the patient in finding the support she needs to cope with stress in her life so she can achieve her health goals (AHA, 2012a). Rationale: Some people perceive stress as overwhelming. Instead of trying to overcome stressful situations by using positive coping skills, they give up and fail to achieve important goals that will help improve their health and well-being. It is important for nurses to teach patients how to cope effectively using positive coping skills (AHA, 2012a). Ineffective coping can lead to bad habits like overeating. Key Problem #4: Imbalanced nutrition: More than body requirements related to poor dietary habits as evidenced by patient being obese. Assessment Data: Patient is 260 lb. Patient has a Body Mass Index (BMI) of 39.5 Patient has history of high cholesterol Short-term goal: Patient will state two poor dietary habits she could change in her own lifestyle by the end of the third cardiac rehab session. Long-term goal: Patient will lose ten pounds in three months. Interventions: 1. Assess the patient's knowledge related to proper nutrition and the role poor nutrition plays in causing heart disease (AHA, 2012d). 2. Educate the patient about daily nutritional recommendations (AHA, 2012d). 3. Teach the patient about foods high in fat, calories, and cholesterol and how to reduce these foods in her diet (AHA, 2012d). 4. Instruct the patient on how to read food labels so she is able to identify and choose healthier foods when she is buying groceries (AHA, 2012e). 5. Assist the patient in setting a weight loss goal and help her plan the steps she will take in order to achieve this goal (AHA, 2012d). Rationale: Poor dietary habits increase a person's risk for heart disease. Excess fat and cholesterol in foods can be deposited in one's arteries and cause plaque to form that can narrow the artery lumen. Severe narrowing of artery lumen can lead to ischemic heart disease or even death (AHA, 2013b)., Key Problem #2- Chest Pain Nursing Diagnoses: Chronic chest pain related to lack of oxygen supply to heart as evidenced by patient stating she has intermittent chest pain at home that is relieved by nitroglycerin. Assessment Data: Recent heart attack Intermittent chest pain Takes nitroglycerin at home Hypertension- B/P 160/92 Short-term goal: Patient will verbalize correct administration of nitroglycerin to relieve chest pain by the end of the first rehab session. Long-term goal: Patient will have chest pain less than once a day within six weeks. Interventions: 1. Teach the patient how to administer nitroglycerin appropriately to successfully relieve chest pain (Gerstenblith and Margolis, 2009). 2. Instruct the patient that if chest pain is not relieved by nitroglycerin to call 911 or go to the emergency room immediately (Gerstenblith and Margolis, 2009). 4. Teach patient the importance of taking a baby aspirin every day in order to prevent the formation of clots that could block their arteries and cause a heart attack (Gerstenblith and Margolis, 2009). 5. Educate the patient about taking their beta blocker medication every day in order to help reduce the occurrence of chest pain (Gerstenblith and Margolis, 2009). Rationale: It is important patients understand how to administer nitroglycerin so they can relieve their angina. Patients also need to realize if their angina is not relieved by chest pain then they should seek immediate medical services because it could mean they are having a heart attack. Aspirin is a drug a person with heart disease may need to take every day in order to prevent blockage of arteries that may cause pain or result in a heart attack. Beta blockers also help prevent chest pain and heart attacks by decreasing the heart rate which gives the heart more time to fill with blood and circulate the oxygen rich blood through the coronary arteries. Beta blockers also decrease the force of the heart's contraction which decreases the heart's oxygen demand further decreasing angina (Gerstenblith and Margolis, 2009). Lack of O2 to heart muscle can cause dyspnea Key Problem #1 - Shortness of breath Nursing Diagnoses: Ineffective air exchange related ventilation/perfusion imbalances as evidenced by patient using purse-lip breathing after walking a short distance. Assessment data: Oxygen saturation dropped from 98-88% after walking. Patient used purse-lip breathing Patient wears oxygen per nasal cannula at 2L/min. continuously History of COPD Currently smokes 2 packs per day. Short-term goal: Patient will be able to identify two important reasons to quit smoking by the second cardiac rehab session. Long-term goal: Patient will develop a plan to quit smoking within one month. Interventions: 1. Teach the patient why it is important to quit smoking such as decreased risk for heart, cardiovascular, and lung disease and less chance of getting lung cancer (American Heart Association [AHA], 2012b). 2. Help the patient decide how they will quit smoking, abruptly or gradually (AHA, 2012b). 3. Determine if the patient needs medications to help them quit smoking (AHA, 2012b). 4. Assist the patient in choosing a quit date and encourage them to quit (AHA, 2012b). Rationale: Smoking for an extended period of time compromises your ability to breathe effectively. Most people can breathe easier after they stop smoking. However, smoking is a tough habit to break. Therefore, nurses have to encourage and support the patient as they take on the challenge (AHA, 2012b)., Key Problem #5- Unable to cope with stress in a positive way Nursing Diagnoses- Ineffective coping related to perceived stress of current illness as evidenced by patient stating, "I just can't do this . . . I wish I never even came here." Assessment Data: Poor coping habits- smoking and eating Negative attitude Lack of self confidence Little ambition to achieve goals Patient stating, "I just can't do this . . . I wish I never even came here." Short-term goal: Patient will be able to state two effective ways to cope with stress by the end of the fourth cardiac rehab session. Long-term goal: Patient will be able to incorporate two positive coping skills into her life within two months. Interventions: 1. Assess how the patient copes with stress currently (AHA, 2012a). 2. Educate the patient about stress management strategies such as staying organized, managing time well, exercising, getting 6-8 hours of sleep each night, taking one step at a time, not worrying about what you cannot change, laughing about something everyday, making time to do things you enjoy, and increasing your self-worth by accomplishing a task or helping others (AHA, 2011). 3. Assist the patient in finding appropriate ways to manage and reduce stress in her own life (AHA, 2012a). 4. Instruct the patient on how to use positive self-talk to change her negative emotions into more positive ones (AHA, 2013a). 5. Assist the patient in finding the support she needs to cope with stress in her life so she can achieve her health goals (AHA, 2012a). Rationale: Some people perceive stress as overwhelming. Instead of trying to overcome stressful situations by using positive coping skills, they give up and fail to achieve important goals that will help improve their health and well-being. It is important for nurses to teach patients how to cope effectively using positive coping skills (AHA, 2012a). Ineffective coping can lead to bad habits like smoking. Key Problem #1 - Shortness of breath Nursing Diagnoses: Ineffective air exchange related ventilation/perfusion imbalances as evidenced by patient using purse-lip breathing after walking a short distance. Assessment data: Oxygen saturation dropped from 98-88% after walking. Patient used purse-lip breathing Patient wears oxygen per nasal cannula at 2L/min. continuously History of COPD Currently smokes 2 packs per day. Short-term goal: Patient will be able to identify two important reasons to quit smoking by the second cardiac rehab session. Long-term goal: Patient will develop a plan to quit smoking within one month. Interventions: 1. Teach the patient why it is important to quit smoking such as decreased risk for heart, cardiovascular, and lung disease and less chance of getting lung cancer (American Heart Association [AHA], 2012b). 2. Help the patient decide how they will quit smoking, abruptly or gradually (AHA, 2012b). 3. Determine if the patient needs medications to help them quit smoking (AHA, 2012b). 4. Assist the patient in choosing a quit date and encourage them to quit (AHA, 2012b). Rationale: Smoking for an extended period of time compromises your ability to breathe effectively. Most people can breathe easier after they stop smoking. However, smoking is a tough habit to break. Therefore, nurses have to encourage and support the patient as they take on the challenge (AHA, 2012b)., Health Care Need: Teaching about risk factors for heart disease and how to reduce future risk of a heart attack. Key Assessments: Chest pain Oxygen Saturation Knowledge deficit Coping skills Dietary habits Physical Activity History of Medical Diagnosis: M.K. is a 56 year-old female who recently had a heart attack. M.K. continues to have episodes of angina at home that are relieved by taking nitroglycerin. M.K. is starting cardiac rehabilitation to improve her heart health and reduce her risk of another heart attack. Physical activity helps reduce risk for heart disease. Key Problem #3- Sedentary Lifestyle Nursing Diagnoses: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by severe exertional dyspnea. Assessment Data: Shortness of breath with little exertion Wears oxygen per nasal cannula at 2 L/min. continuously Smokes two packs per day Uses purse lip breathing after exertion Short-term goal: Patient will exercise to her target heart rate by the end of the third cardiac rehab session. Long-term goal: Patient will be able to ambulate 20 feet with oxygen saturation staying above 93% within six weeks. Interventions: 1. Teach the patient the importance of exercising to her target heart rate in order to strengthen her heart and lungs (AHA, 2012f). 2. Educate the patient about the benefits of exercise which are that it gives you energy, helps you lose weight, and strengthens your bones and muscles (AHA, 2012f). 3. Assist the patient in determining activities that she could do at home everyday in order to meet her daily exercise needs (AHA, 2012c). 4. Encourage the patient to maintain a regular exercise routine and find ways to make exercising fun (AHA, 2012c). Rationale: Being physically active is important to maintain a healthy heart. Adults should exercise at a moderate intensity 30-60 minutes daily for a total of 150 hours per week. A person is more likely to exercise if you teach them the importance of exercising and if you help them identify ways they can include exercise in their daily routine (AHA, 2012c)., Key Problem #5- Unable to cope with stress in a positive way Nursing Diagnoses- Ineffective coping related to perceived stress of current illness as evidenced by patient stating, "I just can't do this . . . I wish I never even came here." Assessment Data: Poor coping habits- smoking and eating Negative attitude Lack of self confidence Little ambition to achieve goals Patient stating, "I just can't do this . . . I wish I never even came here." Short-term goal: Patient will be able to state two effective ways to cope with stress by the end of the fourth cardiac rehab session. Long-term goal: Patient will be able to incorporate two positive coping skills into her life within two months. Interventions: 1. Assess how the patient copes with stress currently (AHA, 2012a). 2. Educate the patient about stress management strategies such as staying organized, managing time well, exercising, getting 6-8 hours of sleep each night, taking one step at a time, not worrying about what you cannot change, laughing about something everyday, making time to do things you enjoy, and increasing your self-worth by accomplishing a task or helping others (AHA, 2011). 3. Assist the patient in finding appropriate ways to manage and reduce stress in her own life (AHA, 2012a). 4. Instruct the patient on how to use positive self-talk to change her negative emotions into more positive ones (AHA, 2013a). 5. Assist the patient in finding the support she needs to cope with stress in her life so she can achieve her health goals (AHA, 2012a). Rationale: Some people perceive stress as overwhelming. Instead of trying to overcome stressful situations by using positive coping skills, they give up and fail to achieve important goals that will help improve their health and well-being. It is important for nurses to teach patients how to cope effectively using positive coping skills (AHA, 2012a). Physical activity can help reduce stress. Key Problem #3- Sedentary Lifestyle Nursing Diagnoses: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by severe exertional dyspnea. Assessment Data: Shortness of breath with little exertion Wears oxygen per nasal cannula at 2 L/min. continuously Smokes two packs per day Uses purse lip breathing after exertion Short-term goal: Patient will exercise to her target heart rate by the end of the third cardiac rehab session. Long-term goal: Patient will be able to ambulate 20 feet with oxygen saturation staying above 93% within six weeks. Interventions: 1. Teach the patient the importance of exercising to her target heart rate in order to strengthen her heart and lungs (AHA, 2012f). 2. Educate the patient about the benefits of exercise which are that it gives you energy, helps you lose weight, and strengthens your bones and muscles (AHA, 2012f). 3. Assist the patient in determining activities that she could do at home everyday in order to meet her daily exercise needs (AHA, 2012c). 4. Encourage the patient to maintain a regular exercise routine and find ways to make exercising fun (AHA, 2012c). Rationale: Being physically active is important to maintain a healthy heart. Adults should exercise at a moderate intensity 30-60 minutes daily for a total of 150 hours per week. A person is more likely to exercise if you teach them the importance of exercising and if you help them identify ways they can include exercise in their daily routine (AHA, 2012c)., Health Care Need: Teaching about risk factors for heart disease and how to reduce future risk of a heart attack. Key Assessments: Chest pain Oxygen Saturation Knowledge deficit Coping skills Dietary habits Physical Activity History of Medical Diagnosis: M.K. is a 56 year-old female who recently had a heart attack. M.K. continues to have episodes of angina at home that are relieved by taking nitroglycerin. M.K. is starting cardiac rehabilitation to improve her heart health and reduce her risk of another heart attack. Smoking is a major risk factor for heart disease. Key Problem #1 - Shortness of breath Nursing Diagnoses: Ineffective air exchange related ventilation/perfusion imbalances as evidenced by patient using purse-lip breathing after walking a short distance. Assessment data: Oxygen saturation dropped from 98-88% after walking. Patient used purse-lip breathing Patient wears oxygen per nasal cannula at 2L/min. continuously History of COPD Currently smokes 2 packs per day. Short-term goal: Patient will be able to identify two important reasons to quit smoking by the second cardiac rehab session. Long-term goal: Patient will develop a plan to quit smoking within one month. Interventions: 1. Teach the patient why it is important to quit smoking such as decreased risk for heart, cardiovascular, and lung disease and less chance of getting lung cancer (American Heart Association [AHA], 2012b). 2. Help the patient decide how they will quit smoking, abruptly or gradually (AHA, 2012b). 3. Determine if the patient needs medications to help them quit smoking (AHA, 2012b). 4. Assist the patient in choosing a quit date and encourage them to quit (AHA, 2012b). Rationale: Smoking for an extended period of time compromises your ability to breathe effectively. Most people can breathe easier after they stop smoking. However, smoking is a tough habit to break. Therefore, nurses have to encourage and support the patient as they take on the challenge (AHA, 2012b)., Health Care Need: Teaching about risk factors for heart disease and how to reduce future risk of a heart attack. Key Assessments: Chest pain Oxygen Saturation Knowledge deficit Coping skills Dietary habits Physical Activity History of Medical Diagnosis: M.K. is a 56 year-old female who recently had a heart attack. M.K. continues to have episodes of angina at home that are relieved by taking nitroglycerin. M.K. is starting cardiac rehabilitation to improve her heart health and reduce her risk of another heart attack. Obesity is a risk factor for heart disease. Key Problem #4: Imbalanced nutrition: More than body requirements related to poor dietary habits as evidenced by patient being obese. Assessment Data: Patient is 260 lb. Patient has a Body Mass Index (BMI) of 39.5 Patient has history of high cholesterol Short-term goal: Patient will state two poor dietary habits she could change in her own lifestyle by the end of the third cardiac rehab session. Long-term goal: Patient will lose ten pounds in three months. Interventions: 1. Assess the patient's knowledge related to proper nutrition and the role poor nutrition plays in causing heart disease (AHA, 2012d). 2. Educate the patient about daily nutritional recommendations (AHA, 2012d). 3. Teach the patient about foods high in fat, calories, and cholesterol and how to reduce these foods in her diet (AHA, 2012d). 4. Instruct the patient on how to read food labels so she is able to identify and choose healthier foods when she is buying groceries (AHA, 2012e). 5. Assist the patient in setting a weight loss goal and help her plan the steps she will take in order to achieve this goal (AHA, 2012d). Rationale: Poor dietary habits increase a person's risk for heart disease. Excess fat and cholesterol in foods can be deposited in one's arteries and cause plaque to form that can narrow the artery lumen. Severe narrowing of artery lumen can lead to ischemic heart disease or even death (AHA, 2013b)., Health Care Need: Teaching about risk factors for heart disease and how to reduce future risk of a heart attack. Key Assessments: Chest pain Oxygen Saturation Knowledge deficit Coping skills Dietary habits Physical Activity History of Medical Diagnosis: M.K. is a 56 year-old female who recently had a heart attack. M.K. continues to have episodes of angina at home that are relieved by taking nitroglycerin. M.K. is starting cardiac rehabilitation to improve her heart health and reduce her risk of another heart attack. Stress is a contributing factor to heart disease. Key Problem #5- Unable to cope with stress in a positive way Nursing Diagnoses- Ineffective coping related to perceived stress of current illness as evidenced by patient stating, "I just can't do this . . . I wish I never even came here." Assessment Data: Poor coping habits- smoking and eating Negative attitude Lack of self confidence Little ambition to achieve goals Patient stating, "I just can't do this . . . I wish I never even came here." Short-term goal: Patient will be able to state two effective ways to cope with stress by the end of the fourth cardiac rehab session. Long-term goal: Patient will be able to incorporate two positive coping skills into her life within two months. Interventions: 1. Assess how the patient copes with stress currently (AHA, 2012a). 2. Educate the patient about stress management strategies such as staying organized, managing time well, exercising, getting 6-8 hours of sleep each night, taking one step at a time, not worrying about what you cannot change, laughing about something everyday, making time to do things you enjoy, and increasing your self-worth by accomplishing a task or helping others (AHA, 2011). 3. Assist the patient in finding appropriate ways to manage and reduce stress in her own life (AHA, 2012a). 4. Instruct the patient on how to use positive self-talk to change her negative emotions into more positive ones (AHA, 2013a). 5. Assist the patient in finding the support she needs to cope with stress in her life so she can achieve her health goals (AHA, 2012a). Rationale: Some people perceive stress as overwhelming. Instead of trying to overcome stressful situations by using positive coping skills, they give up and fail to achieve important goals that will help improve their health and well-being. It is important for nurses to teach patients how to cope effectively using positive coping skills (AHA, 2012a)., Key Problem #3- Sedentary Lifestyle Nursing Diagnoses: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by severe exertional dyspnea. Assessment Data: Shortness of breath with little exertion Wears oxygen per nasal cannula at 2 L/min. continuously Smokes two packs per day Uses purse lip breathing after exertion Short-term goal: Patient will exercise to her target heart rate by the end of the third cardiac rehab session. Long-term goal: Patient will be able to ambulate 20 feet with oxygen saturation staying above 93% within six weeks. Interventions: 1. Teach the patient the importance of exercising to her target heart rate in order to strengthen her heart and lungs (AHA, 2012f). 2. Educate the patient about the benefits of exercise which are that it gives you energy, helps you lose weight, and strengthens your bones and muscles (AHA, 2012f). 3. Assist the patient in determining activities that she could do at home everyday in order to meet her daily exercise needs (AHA, 2012c). 4. Encourage the patient to maintain a regular exercise routine and find ways to make exercising fun (AHA, 2012c). Rationale: Being physically active is important to maintain a healthy heart. Adults should exercise at a moderate intensity 30-60 minutes daily for a total of 150 hours per week. A person is more likely to exercise if you teach them the importance of exercising and if you help them identify ways they can include exercise in their daily routine (AHA, 2012c). Physical activity improves heart health. Key Problem #2- Chest Pain Nursing Diagnoses: Chronic chest pain related to lack of oxygen supply to heart as evidenced by patient stating she has intermittent chest pain at home that is relieved by nitroglycerin. Assessment Data: Recent heart attack Intermittent chest pain Takes nitroglycerin at home Hypertension- B/P 160/92 Short-term goal: Patient will verbalize correct administration of nitroglycerin to relieve chest pain by the end of the first rehab session. Long-term goal: Patient will have chest pain less than once a day within six weeks. Interventions: 1. Teach the patient how to administer nitroglycerin appropriately to successfully relieve chest pain (Gerstenblith and Margolis, 2009). 2. Instruct the patient that if chest pain is not relieved by nitroglycerin to call 911 or go to the emergency room immediately (Gerstenblith and Margolis, 2009). 4. Teach patient the importance of taking a baby aspirin every day in order to prevent the formation of clots that could block their arteries and cause a heart attack (Gerstenblith and Margolis, 2009). 5. Educate the patient about taking their beta blocker medication every day in order to help reduce the occurrence of chest pain (Gerstenblith and Margolis, 2009). Rationale: It is important patients understand how to administer nitroglycerin so they can relieve their angina. Patients also need to realize if their angina is not relieved by chest pain then they should seek immediate medical services because it could mean they are having a heart attack. Aspirin is a drug a person with heart disease may need to take every day in order to prevent blockage of arteries that may cause pain or result in a heart attack. Beta blockers also help prevent chest pain and heart attacks by decreasing the heart rate which gives the heart more time to fill with blood and circulate the oxygen rich blood through the coronary arteries. Beta blockers also decrease the force of the heart's contraction which decreases the heart's oxygen demand further decreasing angina (Gerstenblith and Margolis, 2009)., Health Care Need: Teaching about risk factors for heart disease and how to reduce future risk of a heart attack. Key Assessments: Chest pain Oxygen Saturation Knowledge deficit Coping skills Dietary habits Physical Activity History of Medical Diagnosis: M.K. is a 56 year-old female who recently had a heart attack. M.K. continues to have episodes of angina at home that are relieved by taking nitroglycerin. M.K. is starting cardiac rehabilitation to improve her heart health and reduce her risk of another heart attack. ???? ????, Key Problem #4: Imbalanced nutrition: More than body requirements related to poor dietary habits as evidenced by patient being obese. Assessment Data: Patient is 260 lb. Patient has a Body Mass Index (BMI) of 39.5 Patient has history of high cholesterol Short-term goal: Patient will state two poor dietary habits she could change in her own lifestyle by the end of the third cardiac rehab session. Long-term goal: Patient will lose ten pounds in three months. Interventions: 1. Assess the patient's knowledge related to proper nutrition and the role poor nutrition plays in causing heart disease (AHA, 2012d). 2. Educate the patient about daily nutritional recommendations (AHA, 2012d). 3. Teach the patient about foods high in fat, calories, and cholesterol and how to reduce these foods in her diet (AHA, 2012d). 4. Instruct the patient on how to read food labels so she is able to identify and choose healthier foods when she is buying groceries (AHA, 2012e). 5. Assist the patient in setting a weight loss goal and help her plan the steps she will take in order to achieve this goal (AHA, 2012d). Rationale: Poor dietary habits increase a person's risk for heart disease. Excess fat and cholesterol in foods can be deposited in one's arteries and cause plaque to form that can narrow the artery lumen. Severe narrowing of artery lumen can lead to ischemic heart disease or even death (AHA, 2013b). Increased physical activity can help a person lose weight. Key Problem #3- Sedentary Lifestyle Nursing Diagnoses: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by severe exertional dyspnea. Assessment Data: Shortness of breath with little exertion Wears oxygen per nasal cannula at 2 L/min. continuously Smokes two packs per day Uses purse lip breathing after exertion Short-term goal: Patient will exercise to her target heart rate by the end of the third cardiac rehab session. Long-term goal: Patient will be able to ambulate 20 feet with oxygen saturation staying above 93% within six weeks. Interventions: 1. Teach the patient the importance of exercising to her target heart rate in order to strengthen her heart and lungs (AHA, 2012f). 2. Educate the patient about the benefits of exercise which are that it gives you energy, helps you lose weight, and strengthens your bones and muscles (AHA, 2012f). 3. Assist the patient in determining activities that she could do at home everyday in order to meet her daily exercise needs (AHA, 2012c). 4. Encourage the patient to maintain a regular exercise routine and find ways to make exercising fun (AHA, 2012c). Rationale: Being physically active is important to maintain a healthy heart. Adults should exercise at a moderate intensity 30-60 minutes daily for a total of 150 hours per week. A person is more likely to exercise if you teach them the importance of exercising and if you help them identify ways they can include exercise in their daily routine (AHA, 2012c).