Decreased Cardiac Output and Ineffective Cerebral Tissue Perfusion related to Syncope

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Decreased Cardiac Output and Ineffective Cerebral Tissue Perfusion related to Syncope

Definition of Syncope

Syncope is a body mechanism to anticipate changes in the blood supply to the brain and usually occurs suddenly and briefly or loss of consciousness and postural body strength and the ability to stand, because of the reduction of blood flow to the brain. Fainting, "blacking out", or syncope can also be interpreted as a temporary loss of consciousness followed by the return of full alertness.

Syncope is a final establishment of the body in maintaining a lack of substances important for supply to the brain such as oxygen and other substances (glucose) from the damage that could be permanent.


Causes of Syncope

Factors that can trigger syncope is divided into two, namely: psychogenic factors (fear, tension, emotional stress, severe pain that occurs suddenly and unexpectedly and fear the sight of blood or medical equipment such as syringes) and non-psychogenic factors (upright sitting position, hunger, poor physical condition, and the environment is hot, humid and dense).

The most frequent cause of syncope can be divided into several sections such as:

1. Cardiac (Heart) and blood vessels
Heart Blockages: Disturbances in the heart can be caused by a blockage (obstruction) in the heart of this blockage can be caused by heart valve disorders, tumors and enlargement of the heart muscle and heart diseases.
Heart electricity: Electrical disorders of the heart, causing arrhythmia and cardiac pulsation frequency so that the volume of blood pumped to the body and to the brain will also be reduced.
Vertebrobasilar system: The narrowing of the blood vessels due to age, smoking, high blood pressure, high cholesterol, and diabetes. Vertebrobasilar system is risky for the narrowing, and if there is a temporary interruption in blood flow to the midbrain and reticular activating system, fainting or syncope may occur.

2. Innervation
Vasovagal syncope: In the human body there are reflexes in the nervous system that are not aware, this nerve reflex can cause a sudden drop in blood pressure. Vasovagal syncope as a result of the action of the vagus nerve which then sends signals to the heart and then slow the heart rate so someone fainting. Vasovagal syncope is usually triggered by fear, pain, injury, fatigue and prolonged standing. Other situations generally cause the heart rate to slow down and cause fainting while as straining, coughing, sneezing (Ocupational syncope) that can cause vagal response.
Carotid Sinus: Carotid Sinus is a part of the blood vessels of the neck are very sensitive to physical changes and strain the blood vessels in the area. Because it is too sensitive, then this will result in impulse transmission in the central nervous system that stimulates nerves that make losing consciousness.

3. Influence of body position
Orthostatic Hypotension.
Postural Hypotension: Blood vessels need to maintain their strength so that the body can withstand the effects of gravity with changes in position. When the body position change from lying to standing, autonomic nervous system increases the strength of the walls of blood vessels, making them shrink, and at the same time increasing the heart rate so that blood can be pumped went up to the brain that cause the blood pressure is relatively low at the moment stand. This is common in the elderly and pregnant women. Typically, fainting happens when a person stands with fast and there was not enough time for the body to compensate. This makes the heart beat faster, and occurs vasoconstriction of blood vessels to maintain the body's blood pressure and blood flow to the brain.

4. Lack of body components
Hypoglycemia: Decreased blood sugar suddenly causes a decrease in glucose available to brain function. This can be seen in diabetics who tend to overdose of insulin. If people miss a dose, the dose may be tempted to take extra insulin to make up the missed dose. In such cases, blood sugar tends to suddenly fall, and get people into insulin shock.
Electrolyte imbalance: This is due to changes in the concentration of fluid in the body and also directly affects blood pressure in the body.
Anemia: Anemia is a condition of a lack of red blood cells (erythrocytes), more specifically, is a hemoglobin (Hb). This causes a lack of oxygen reaching the brain that causes fainting, because hemoglobin is to transport oxygen to the cells in this case the cells in the brain.

5. Other causes
Pregnancy: It is caused by the pressure of the inferior vena cava (the large vein that returns blood to the heart) by the enlarged uterus and by orthostatic hypotension.
Medications: Other medications may also cause potentially of fainting or syncope including those for high blood pressure that can dilate blood vessels, antidepressants which can affect the heart's electrical activity, and that affects the mental state such as pain medications, alcohol, and cocaine.


Clinical Manifestations of Syncope

Signs symptoms of syncope can be seen in three phases which pre-syncope, syncope and post syncope.

1. Pre syncope:
Patients may feel nauseous, feeling uncomfortable, clammy and weak. There may be a feeling of dizziness or vertigo (the room spinning), hyperpnea (increased depth of breath), vision may be blurred, and there may dampen hearing and tingling sensations in the body. Pre-syncope or near-fainting, the same symptoms will occur, but at this stage the blood pressure and pulse down and the patient did not really lose consciousness.

2. Syncope:
Syncope is characterized by loss of consciousness of patients with clinical symptoms such as:
Short breathing, shallow and irregular.
Bradycardia and hypotension continues.
Palpable pulse weak and convulsive movement in arm muscles, legs and face. In this phase the patient vulnerable to airway obstruction due to the occurrence of muscle relaxation due to loss of consciousness.

3. Post syncope:
The last phase is the post syncope is a recovery period where patients return to consciousness. In the early phases of post-syncope patients may experience disorientation, nausea, and sweating. On clinical examination obtained palpable pulse began to rise and stronger and the blood pressure starts to rise.
After the episode of syncope, the patient should return to normal mental functioning, even though there may be signs and other symptoms depending on the underlying cause of syncope. For example, if the patient is in the midst of a heart attack, he may complain of chest pain or chest pressure.


Nursing Diagnosis and Interventions for Syncope

Nursing Diagnosis : Decreased cardiac output related to the disruption of blood flow to the heart muscle.

Goal: inadequate blood flow to the heart.

Expected outcomes: strong pulse palpation, normal blood pressure.

Intervention:
1. Check the ABC and if necessary freed airway and cardiac massage
Rational: Addressing critical condition early may improve the prognosis of clients.

2. Monitor the pulse rate, respiratory rate, BP regularly.
Rational: Vital signs as the reference condition the patient's circulation.

3. Check the state of the client's heart with ECG examination.
Rational: ECG examination provides an overview heart condition and help determine further treatment alternatives.

4. Assess changes in skin color towards cyanosis and pallor.
Rational: Pale showed a decrease in peripheral perfusion to inadequate cardiac output. Cyanosis occurs as a result of obstruction of blood flow to the ventricles.

5. Monitor intake and output every 24 hours.
Rationale: The kidneys respond to lower cardiac output with production hold fluid and sodium.

6. Limit activities adequately.
Rationale: Adequate rest is needed to improve the efficiency of cardiac contraction and lower oxygen consumption and excessive work.


Nursing Diagnosis : Ineffective Cerebral Tissue Perfusion related to a decrease in the flow of oxygen to the cerebral.

Expected outcomes: Vital signs are stable, patient-oriented with good communication.

Interventions:
1. Monitor vital signs
Rational: Vital Signs is one indicator of the general state and the patient's circulation.

2. Position the patient in the shock position foot raised 45 degrees.
Rationale: Helps improve venous return to the heart and subsequently increased cerebral blood flow.

3. Monitor the level of consciousness.
Rationale: The level of a person's consciousness is also influenced by the perfusion of oxygen to the brain.

4. Provide adequate oxygen therapy.
Rationale: to prevent more severe brain hypoxia.

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