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NURS1020 Care Card #2

Feb 3rd- Feb. 8 2016

Health Condition (definition)

Signs & Symptoms

Cerebrovascular accident
(CVA)
More commonly known as a
stroke, a CVA is caused by
restricted blood flow to the
brain, causing the tissue to
die.
Ischemic strokes occur when
a clot causes a blockage.
Hemorrhagic strokes occur
when vessels break resulting
in bleeding in the brain.

weakness/numbness
of the face/leg/arm
(typically one side)
confusion, difficulty
speaking/understandin
g speech
blurred vision
dizziness, loss of
coordination or
balance, difficulty
walking
*all sudden

Nursing Consideration

Hypertension
more commonly referred to as
high blood pressure which is
any blood pressure over
140/90. Can be controlled
through medication and/or
changes in lifestyle.

Symptoms do not
typically appear until
there is damage from
chronic high blood
pressure.
Uncontrolled high
blood pressure can
cause stroke, heart &
kidney failure, or heart
attack.

Dementia (mild-unspecified)
does not refer to a specific
disease but an umbrella term
for a group of symptoms
(caused by disorders affecting
the brain)
effects 2+ brain functions

reduced ability to
perform everyday
tasks
memory loss
(extremely common)
difficulty with
language
reduced ability to
control
emotions/problem
solve
may hallucinate
become agitated

Improving mobility
Develop exercise plan
Rehabilitation of
damaged areas (face,
arms, legs)
Prevent pain
Encourage personal
hygiene and self care
Assist with nutrition
plan
Rehabilitation for
bowel/bladder control
Improving though
process/communicatio
n
Inform family/friends
of their roles in the
recovery process
monitor BP and other
vitals and skin colour
encourage/assist with
self care
environment: quiet,
calm
reduced activity
physician ordered
medication
reminders and
discussion about
recent/upcoming
events
create and maintain a
schedule
reduce stressful
situation and
environments
help with word loss by
suggesting words
assess ability to
provide self care
be patient

ignore inconsistency
or misinformation
(allow for patient to
live in the world their
mind has created)
encourage stimulating
activities as well as
quiet time
remove potentially
harmful objects
adequate lighting and
other environmental
factors

Diabetes
a disease where blood glucose
levels are too high because
the body is not producing
enough insulin (Type II) or is
not producing any insulin
(Type I)

excessive thirst
fatigue
increased urination
increased hunger
tingling/numbness of
hands/feet
weight loss
frequent infection
slow healing wounds
lack of concentration
blurred vision
vomiting & stomach
pain

Chronic Kidney Disease


means the kidneys have been
damaged and can no longer
filter blood adequately. It is
most commonly caused by
hypertension and diabetes and
leads to a buildup of waste in
the body. It can lead to kidney
failure and other health
problems

changes in urination
frequency
colour
pale
urine &
more
dark
urine &
less
volume
pressure/diffic
ulty during

recording &
maintaining body
weight
create a meal plan
and/or discuss foods
to avoid
insulin therapy
monitoring blood
glucose levels
monitor for signs and
symptoms of
hypoglycemia
maintain
fluid/electrolyte
balance
educate patient on
their disease and the
necessary care they
must take to prevent
progression or
complications
monitoring urinary
output and liquid
intake
medication/treatment
for rashes
maintaining nutrition
monitoring
neurological
competency
reducing risk of falls
by monitoring
dizziness, fatigue and

may contain
blood
may be foamy
edema/swelling
fatigue (reduced
production of
hormone secreted by
the kidneys, EPO)
skin rash/itching
bad breath & changes
in taste
reduced appetite
SOB
N&V
dizziness & trouble
concentrating

Renal Failure
is the final stage of chronic
kidney disease

*see Chronic Kidney Disease

mobility
maintaining fluid
levels through
vomiting
monitoring oxygen
sats and respiratory
abilities
monitor for
progression of the
disease towards renal
failure

(Blindness in right eye caused


by) Macular Degeneration
which destroys sharp, central
vision.
Wet: abnormal blood vessels
grow under the macula which
leak blood & fluid (quick)
Dry: light-sensitive cells
within the macula break down
(slow)

distortion of straight
lines
gradual loss of central
vision
whiteout or dark
blurry vision in centre
of vision

assess hypertension
and changes, lung and
heart sounds
monitor for dyspnea
and pain
prepare patient for
dialysis by informing
them of the risks and
requirements and
gaining consent
educate patient on
aftercare
educate family

monitor prior to
diagnosis for potential
age related macular
degeneration,
specifically wet.
current
treatments can
stop the rapid
progression of
wet macular
degeneration
to blindness,
subsequently
improving the
quality of life
of the patient
involve patients and

family members in
diagnosis
educate patient and
family members on
possible progression
to blindness
monitor progression
especially or wet (fast)
treatment education
and after care for wet
macular degeneration
Chronic Heart Failure
can affect one or both sides of
the heart and means that the
heart is incapable of pumping
the required amount of blood
to the body

SOB
fatigue
edema
swelling of the veins
of the neck
weight gain
frequent urination
cough (acute
pulmonary edema)

Coronary Artery Disease


is the most common type of
heart disease. The arteries that
supply blood to the heart
harden and narrow caused by
plaque and cholesterol
buildup

angina
SOB
heart attack
heart failure
arrhythmia
muscle damage to
heart
&/or blocked artery
*silent CAD/CHD is where
there are no signs and
symptoms

assess for abnormal


heart & lung sounds
monitor blood
pressure and pulse
monitor level of
consciousness
monitor temperature
and oxygen saturation
encourage rest in
between activities
encourage patient to
assume high fowlers
position and assist in
positioning
encourage bed rest
and sleep
educate patient on the
medications they are
taking for their
disease(s)
record length and
intensity of pain of
anginal episodes
monitor blood
pressure and heart rate
during anginal
episodes
educate patient on
their medication
record the dosage used
during episodes of
medication
explain cardiac
catheterization
create a diet for the

patient
monitor stressors and
attempt to reduce
patients stress
if scheduled for
surgery prepare
patient for surgery and
post op care

Obstructive Sleep Apnea


is when the narrowing of the
airways or an obstruction
occurs causing your breathing
to become very shallow or
stop

Snoring becomes loud


Snoring is interrupted
by long silent period
when breathing stops
Silence is followed by
loud snort and gasp
May feel increased
fatigue during the day
or act grumpy,
impatient, and irritable

Anemia
is when your blood does not
carry enough oxygen to the
rest of your body. Your body
needs iron to make
Hemoglobin. Three main
causes, blood loss, lack of red
blood cell production, and
high rates of blood cell
destruction.

Fatigue or feeling
weak
SOB
Dizziness
Headache
Cold hands and feet
Pale skin
Chest pain

Hyperlipidemia
is when you have high levels
of cholesterol that stick to the
walls of your arteries.

Gastroesophageal Reflux
Disease
is when muscle at the end of
your esophagus does not close
properly allowing stomach
contents to leak back or reflux
into your esophagus, which
causes irritation.

Encourage sleeping on
the side
Avoid alcohol
consumption before
sleep
Monitor the cause of
possible obstructions
If a breathing machine
is prescribed educate
the patient on how to
use it
Monitor iron levels
Ensure patient is
educated about their
prescriptions
Follow physician and
dietician orders

Usually no symptoms
in early years
Possible heart attack
and diabetes

Burning in chest or
throat (heartburn)
Taste stomach fluid in
back of the mouth
Dry cough
Asthmatic symptoms
Difficulty swallowing

Alter nutrition
Monitor cholesterol
Weight management
Exercise

Monitor diet
Reduce stressors such
as food
Limit alcohol
consumption
Cut up food in smaller
pieces to allow for
easier digestion
Inform patient on
medications available

References
MedlinePlus - health information from the national library of medicine. (2016, February 12).
Retrieved March 9, 2016, from MedlinePlus, https://www.nlm.nih.gov/medlineplus/
NANDA international - defining the knowledge of nursing. (1997, September 08). Retrieved
March 9, 2016, from http://www.nanda.org/
Potter, P. A., Perry, A. G., Canadian, Ross-Kerr, J. C., & Wood, M. J. (2014).
Fundamentals of nursing (Canadian fundamentals of nursing) (5th ed.). Toronto: Elsevier
Science Health Science div.