Care for patients with coronary heart disease is provided by professional nursing staff during hospitalization, while strengthening daily care after discharge for specific patients’ clinical types of coronary heart disease, cardiac function status and general comprehensive health conditions has a significant impact on their treatment effect, organism recovery and clinical prognosis.
The daily care of coronary heart patients mainly includes the following aspects.
I. Diet care
Improper diet is one of the important causes of the disease. Scientific and reasonable dietary care can stabilize coronary heart disease, prevent further deterioration, avoid or reduce the occurrence of acute cardiovascular events, and improve the quality of survival of patients. According to the recommendation of World Health Organization, the diet of coronary heart disease should follow the principle of “five low and two high”.
1, low calorie: When the total calorie intake exceeds the consumption, the remaining calories will be accumulated in the body and turned into fat. In life, the incidence of coronary heart disease in obese people is higher than the average person, so coronary heart patients should maintain a low-calorie diet. Obese people can supply 20kcal per kilogram of body weight per day, 25kcaL for bed rest, 30kcal for light activity. because the calculation of calories is not easy for the general public to operate, just pay attention to not eating too much at each meal, reaching about 80%. The amount of dinner should be even less, and advocate light activities after meals, such as walking, etc.
2. Low fat: The change of serum cholesterol level is closely related to the total amount of fat in food, so the content of fat in daily diet should be less than 30% of total calories. In addition, the change of serum cholesterol level is related to the type of fat, animal fat is easy to raise serum cholesterol, while vegetable fat (except coconut oil) has the effect of inhibiting thrombosis and stopping the development of atherosclerotic lesions, so low fat is to limit animal fat.
3, low sugar: mainly to limit the intake of starch. Refined rice, refined flour is rich in sugar, too much sugar can lead to an increase in blood triglyceride content, so the total amount of sugar in the daily diet should account for 55% C60% of total calories is appropriate. Since coarse grains and grains are rich in fiber, which is beneficial to the elimination of cholesterol, it is advocated that the diet should have an appropriate proportion of coarse grains.
4. Low protein: The intake of protein should be appropriately limited to 10%Cl 5% of the total calories. Patients with coronary heart disease should pay attention to the selection of high-quality protein containing essential amino acids, such as fish, milk and beans and soy products. In this way, not only can meet the body’s protein needs, but also avoid increasing the patient’s liver and kidney burden due to excessive protein intake.
5, low salt: too much salt can aggravate the body’s sodium retention, raise blood pressure, which is not good for coronary heart disease. Therefore, we should pay attention to limit the intake of salt: the total amount of salt in the daily diet should be below 5 grams. For patients with heart failure after myocardial infarction, salt intake should be even lower, below 3 grams per day. Residents in northern areas of China usually consume more salt, often reaching 12-20 grams per day, so residents in northern areas of coronary heart patients should pay special attention to low-salt diet.
6, high vitamin: water-soluble vitamins B, C and P can affect the anabolism of cells and their interstitial components, promote tissue repair, reduce the brittleness of the blood vessel wall, enhance the toughness and elasticity, enhance the resistance of microvasculature, which is conducive to the protection and improvement of the vascular status, so pay attention to the supplementation of fresh vegetables and fruits rich in vitamins, the daily total of 500g or more. Apples, pears, peaches, citrus, hawthorn and other fruits, as well as radishes, cucumbers and green leafy vegetables are rich in water-soluble vitamins, are generally able to fully supplement the body’s needs, without long-term large doses of vitamin supplements, otherwise it will likely harm health.
7, high fiber: dietary fiber is a polysaccharide, the body can not be completely decomposed and used, eat more can increase the discharge of cholesterol in the stool, reduce the concentration of cholesterol in the serum, and soften the stool to prevent constipation. Therefore, you should eat more cereals, fruits and vegetables containing fiber, such as corn, millet, celery, leeks, fungus, cauliflower, etc.
In addition, coronary heart patients should also pay attention to less alcohol in their diet and drink less drinks containing sugar and alcohol. Although a small amount of low-concentration wine can improve blood HDL-C and red wine has antioxidant effects, long-term alcohol consumption can cause other problems, so it is not advocated to prevent coronary heart disease by drinking alcohol. Do not drink strong alcohol.
In short, a reasonable diet should be coarse and fine, reasonably matched, not sweet and salty, not more rather than less, three, four, five meals, seven or eight minutes full.
Second, psychological care
The physiological and psychological activities of human are two systems that are interrelated and affect each other. The damage and limitation of physiological functions often affect the process of psychological activities, which in turn affects the physiological activities and the treatment and rehabilitation of physical diseases. Coronary heart disease belongs to the category of psychosomatic diseases, no matter in the development of the disease or recovery process, the influence of mental and psychological factors on the disease cannot be ignored.
It has been found that patients with coronary heart disease have different types of psychological problems in different degrees, and appropriate psychological interventions are important for the treatment and prognosis of coronary heart disease. Factors affecting the degree and type of psychological problems of patients mainly include somatic symptoms, physical condition, personality characteristics, age, social and family roles, economic status, literacy, and disease-related knowledge background. Psychological care should address the negative psychological characteristics such as fear, anxiety, depression, apprehension, pessimism, disappointment and over-dependence, maintain a positive and optimistic attitude, and establish confidence in overcoming the disease. It is also important to pay attention to the adverse consequences caused by blind optimism and overconfidence while ignoring the possibility and danger of disease progression, as well as the necessity of secondary prevention and scientific rehabilitation.
III. Exercise care
Exercise rehabilitation is an important part of the overall medical treatment and rehabilitation of coronary heart disease. Studies have shown that a formal exercise rehabilitation program can effectively improve functional reserve, enhance mobility, reduce emotional depression, reduce cardiovascular mortality, alleviate ischemic symptoms, reduce the risk of recurrent coronary events and improve quality of life, and also help overcome negative inattentive attitudes that impede treatment. In the daily exercise care of patients with coronary artery disease, personalized rehabilitation programs and exercise prescriptions should be developed and patients should be guided to perform rehabilitation training in stages according to their underlying disease, overall health and fitness status, and personal interests. During the implementation of the exercise rehabilitation program, the results should be monitored and evaluated, and the exercise prescription should be modified at the appropriate time to ensure both the rehabilitation effect and safety. Patients taking anti-platelet drugs may lead to abnormal hemostasis, and injury and bleeding should be avoided during exercise rehabilitation.
1.Select the type of exercise: For patients with coronary heart disease, it is appropriate to do quantitative endurance exercise, mainly referring to walking, jogging, cycling, swimming and other continuous cyclic exercise with the participation of large muscle groups. Suitable physical exercise programs for patients with coronary heart disease mainly include but not limited to.
(1) Walking: It is the most preliminary exercise in the rehabilitation exercise of coronary heart disease, and is also the basis of other exercises. Walking is a whole body exercise, not only can make the limbs and waist muscles, bones get activity and exercise, but also can make the myocardial contraction force increase, peripheral vascular expansion, vascular spasm release, vascular smooth muscle relaxation, and thus has the effect of enhancing cardiac function, lowering blood pressure and preventing coronary heart disease. Some data show that people who adhere to more than 20 minutes of walking per day, the incidence of abnormal myocardial ischemic changes in the electrocardiogram is 1/3 lower than those with less activity. walking as an exercise program, each time you can walk 45C60 minutes, or daily walking 1000C2000m, interspersed with fast walking (more than 100 steps per minute of fast walking, the heart rate can reach 100C110 times / min). Walk with even stride, stable gait, natural breathing, and prevent falls.
(2) jogging: jogging should be done first to prepare for the exercise, wear sports shoes that fit, keep a relaxed pace when running, pay attention to the ground and the surrounding environment, to prevent losing your footing. Jogging can also be crossed in walking, after running can jogging, or do physical activities, gymnastics and other actions.
(3) cycling: exercise should be the height of the seat and handlebar curvature adjustment, travel to keep the body slightly leaning forward, to avoid force grip, suitable for exercise in the sports field. If the conditions can be applied to power bicycle exercise indoors, it has the advantage of standardization of the amount of exercise, easy to observe and compare.
(4) swimming: better physical strength, the original can swim, and conditions can be long-term persistent people, can engage in this physical exercise, but should be ready to exercise, and should avoid too long exercise to prevent muscle cramps.
Other exercise programs are taijiquan, gymnastics and qigong, etc., can be selected according to the specific circumstances.
2, exercise intensity: the so-called exercise intensity is the exercise load, theoretically speaking, to exercise in the oxygen uptake rate as a percentage of the maximum oxygen uptake rate as an indicator to measure the intensity of exercise is the most ideal. But the oxygen uptake rate in the actual exercise is not easy to grasp, and in general the heart rate and oxygen uptake rate parallel, so the most practical indicator to reflect the size of the exercise intensity or heart rate. However, for patients with bradyarrhythmias, such as sick sinus node syndrome or atrioventricular block of second degree or higher, heart rate cannot be used to measure exercise intensity. The heart rate during exercise as a percentage of the expected maximum heart rate (the maximum heart rate measured in the limit exercise experiment) represents the intensity of exercise, and a good grasp of exercise intensity is a key issue for improving heart function and increasing physical work capacity. Theoretically speaking, only when the heart rate reaches 70% C85% of the maximum heart rate (at least more than 50%) during exercise, can the maximum oxygen uptake rate be increased and a better rehabilitation effect be produced. Exercise at these levels is generally associated with sweating, increased breathing, and a feeling of mild exertion (but not discomfort).
The indicators of the appropriateness of the exercise level are the patient’s self-perception and the heart rate during the activity. Too little exercise will not achieve the rehabilitation goal, while too much exercise will put too much burden on the heart, and the results will be counterproductive. The normal human heart rate is 60-100 beats per minute. The appropriate heart rate for exercise can be calculated by subtracting the number obtained by age from 170. For example, the appropriate heart rate for a 60-year-old patient during exercise is 170-60 = 110 beats per minute, and should not exceed 20 beats at most, that is, not more than 130 beats per minute, otherwise it can be judged as too much exercise. Like sprinting, soccer, basketball and other projects when the exercise heart rate is generally more than 140-150 times per minute, so it is not suitable for patients with coronary heart disease.
3, the duration of exercise: if there is no discomfort, each exercise lasts at least 30 minutes or more.
4, the frequency of exercise: 5 times a week or more, preferably every day to adhere to.
5, precautions: Although physical exercise is beneficial to patients with coronary heart, but if carried out improperly, not only can not benefit, but bring risks and hazards to patients. Therefore, when participating in physical exercise, the following issues should be noted.
(1) Unstable angina, early acute myocardial infarction, coronary artery disease combined with cardiac insufficiency, is not suitable for physical exercise. If you want to do sports exercise, you should do it after evaluation by medical personnel.
(2) Avoid exercising within 2 hours of eating a lot, drinking strong tea, coffee, etc., and should not eat or drink strongly within 1 hour after exercise.
(3) Do not drink or smoke before exercise.
(4) exercise should not be carried out in the early morning, you can choose about 10:00 am.
(5) avoid emotional excitement before and after exercise. Because mental tension and emotional excitement can increase the blood catecholamines, lowering the threshold of ventricular fibrillation, coupled with the risk of inducing ventricular fibrillation, so for unstable angina or stable angina attack within 3 days, as well as patients within six months after myocardial infarction, should not do more strenuous exercise.
(6) Exercise should be gradual and persistent, and those who do not normally exercise should not suddenly engage in strenuous exercise.
(7) large amount of exercise, should avoid wearing too thick, affecting heat dissipation increase heart rate, heart rate increases will make the myocardial oxygen consumption increase.
(8) immediately after exercise to avoid taking a hot bath or shower with hot water, at least 15 minutes after rest, and control the water temperature at 40 degrees or less. Because the whole body immersed in hot water, is bound to cause extensive vasodilation, and the heart blood supply relatively reduced.
(9) The amount of exercise should be reduced during the high temperature and high humidity season.
In short, the early exercise of coronary heart patients should be under the guidance of medical personnel, starting with small and light amounts, gradually and consistently. If the condition changes, re-evaluation should be done.
Fourth, medication care
Medication is an important means to promote recovery and prevent relapse, but there are many factors that affect the adherence and efficacy of medication in the process of treatment and recovery. First, medication should be taken at the prescribed time according to medical prescriptions; second, if adverse drug reactions or unsatisfactory treatment results occur, you should promptly follow up and ask a professional doctor to adjust the medication regimen, not to read the manual or listen to the “experience” of friends and relatives to increase or stop medication; third, you should not listen to advertisements and apply health care products instead of effective key drugs; fourth, at the same time, you should not listen to advertisements and apply health care products instead of effective drugs. Fourth, when taking multiple drugs at the same time, you should not wait until the last drug is finished before prescribing it, because this may lead to a sudden interruption of the first drug, which may lead to serious consequences, such as the sudden discontinuation of beta-blockers may occur serious arrhythmia or myocardial infarction, and the sudden discontinuation of Polivy and aspirin in patients with recent stent implants may lead to stent thrombosis and acute closure of blood vessels. The thrombosis and acute occlusion of blood vessels may occur.
V. Life care
The content of life care mainly includes.
1, environmental care: a good environment makes the patient’s spirit happy, improves appetite and promotes recovery. To keep the room clean and tidy and fresh air, environmental temperature and humidity appropriate.
2, sleep care: sleep is a physiological function of regular renewal of self-preservation produced by human evolution, good sleep is the basic requirement for normal growth and development of the human body and maintenance of health. Sleep disorders may affect physical health, reduce the quality of life, damage interpersonal relationships, affect social performance, and even lead to accidents or death. For patients with coronary artery disease, it is especially important to ensure good sleep. In sleep care, we should pay attention to let patients develop regular sleep habits; don’t eat before going to bed, try to keep an empty stomach; don’t drink coffee and tea before going to bed; keep the appropriate temperature and humidity in the room; the light should not be too strong; change and maintain the appropriate sleeping posture; wash feet with warm water before going to bed to eliminate fatigue, etc.
3, the prevention and care of constipation: middle-aged and elderly patients are prone to constipation, especially the high incidence of constipation in elderly cardiac patients. This is closely related to the patient’s medication, lying, physiological, psychological and other factors. If the patient is bedridden for a long time to eat less, the digestive function is reduced, easily cause constipation. There are also patients who are not accustomed to the use of the stool, stool force and produce a kind of action, deep inhalation after holding the breath, can induce arrhythmia, especially myocardial infarction patients stool force can prompt the heart rupture. Therefore, it is very important to pay attention to the patient’s constipation care.
4, due to the time care: this aspect is still temporarily not attached to people. Modern chronobiological research reveals that the laws of human life words change by the four natural seasons and circadian rhythms. Experimental observation found that the changes of human body temperature, respiration, pulse, blood pressure, energy metabolism, electrocardiogram, etc. are in line with the circadian rhythm of yin and yang changes, and the secretion of glucocorticoid hormone also has circadian rhythm, which are all physiological time rhythms. There is also a large amount of research evidence on the effect of temporal factors on the human body in pathological states. For example, patients with coronary artery disease have more chances of ischemic events in the cold winter and spring seasons; stable angina mostly develops during daytime, while variant angina mostly attacks at night, etc. Therefore, we nursing staff understand the seasonal and circadian rhythm patterns related to the occurrence of coronary artery disease attacks, and carry out work and life regulation and drug prevention in advance, which can avoid or reduce and mitigate the damage caused by disease attacks to the organism. Cholesterol is one of the most important risk factors for coronary heart disease, and HMG-COA reductase, the rate-limiting enzyme in the early stages of cholesterol synthesis in human hepatocytes, has the highest activity at night, so taking statins at night can produce better cholesterol-lowering efficacy.