Syncope Nursing Care Plans Diagnosis and Interventions
Syncope NCLEX Review and Nursing Care Plans
Fainting or passing out is clinically termed as a syncopal episode or syncope. Syncopal episodes are primarily characterized by a temporary, rapid decrease in blood supply to the brain, which results in loss of awareness and movement control.
The person then collapses or rolls over, allowing blood to resume to the brain. Hence, the resumption of blood flow permits the individual to regain consciousness.
Furthermore, syncope is a symptom caused by various illnesses ranging from benign to life-threatening.
Many non-life-threatening reasons, such as overheating, malnutrition, excessive perspiration, tiredness, or blood pooling in the legs due to rapid changes in body position, can cause syncope. It is critical to identify the etiology of syncope and any underlying disorders.
In addition, syncope occurs more frequently than expected. It can happen at any age, even in childhood. However, syncope happens more often in older individuals.
Syncopal episodes are usually brief, lasting only a few seconds or minutes. Thus, when the patient regains consciousness, they may have a brief period of bewilderment.
Types of Syncope
- Vasovagal Syncope. The most prevalent type of syncope is vasovagal syncope, which is also referred to as cardio-neurogenic syncope. It is triggered by an abrupt reduction in blood pressure, which reduces blood supply to the brain. Due to gravity, blood settles in the lower body region, below the diaphragm, upon standing up. The autonomic nervous system (ANS) and the heart work together to maintain normal blood pressure when this happens. Orthostatic hypotension affects some patients with vasovagal syncope. This disorder prevents the patient’s blood vessels from contracting as they should when they stand and causes blood to accumulate in the legs, resulting in a significant decrease in blood pressure.
- Situational Syncope. Situational syncope is a kind of vasovagal syncope. It only occurs under certain circumstances that influence the neurological system and cause syncope. Some of these instances are as follows:
- Extreme emotional stress
- Anxiety attacks
- Episodes of pain or discomfort
- Influence of alcoholic beverages or medicines
- Hyperventilation (breathing oxygen too heavily and exhaling too much carbon dioxide too quickly)
- Coughing aggressively, moving the neck, or wearing a collar that is too closed (carotid sinus hypersensitivity)
- Excessive urination (micturition syncope)
- Postural Syncope. Postural tachycardia (also called postural hypotension) Postural syncope is characterized by a rapid reduction in blood pressure induced by a sudden change in position, such as rising from supine to upright. Some drugs, as well as dehydration, can cause this syndrome. Thus, when patients with this form of syncope stand, their blood pressure drops typically by at least twenty mmHg in systolic and at least ten mmHg in diastolic.
- Cardiac Syncope. A heart or blood vessel problem that causes impaired blood flow to the brain causes cardiac syncope. An irregular heartbeat (arrhythmia), restricted blood flow in the heart related to structural heart disease, valve dysfunction, obstruction in the cardiac blood vessels (myocardial ischemia), aortic stenosis, hemorrhage, or heart failure are examples of these disorders. If the patients develop cardiac syncope, they should consult a cardiologist immediately for effective treatment.
- Neurologic syncope. A neurological disorder, such as a seizure, stroke, or transient ischemic attack, causes neurologic syncope (Transient Ischemic Attack). Headaches or migraines and normal pressure hydrocephalus are two less prevalent causes of neurologic syncope.
- Postural Orthostatic Tachycardia Syndrome (POTS). Postural-Orthostatic Tachycardia Syndrome is characterized by an extremely rapid heart rate or tachycardia that occurs when a person stands up from a reclining or lying down position. The heart rate is expected to increase by 30 beats per minute. Typically, the rise occurs within 10 to 15 minutes of standing. The condition is more prevalent among women, but it can also happen in men.
Causes of Syncope
Syncope can be induced by a medical illness or by external factors. Emotional reaction to a distressing event, intense pain, low blood sugar, or a shift in blood volume can also cause fainting or syncope. Thus, if the blood pressure or respiratory rate drops suddenly, the patient may faint.
The following factors commonly cause syncope:
- Dilated blood vessels or hypotension
- Heartbeat irregularity
- Unusual posture changes, such as standing up too rapidly, can cause blood to accumulate in the lower legs.
- Standing for an extended period.
- Tremendous agony or terror
- Severe tension
Risks Factors of Syncope
- Age. 80-year old adults and above are more likely to experience syncope, resulting in hospitalization and death.
- Underlying health conditions, such as hypotension and other cardiac diseases
- Severe dehydration or electrolyte imbalance
- Orthostatic stress
- A medical history of abrupt cardiac arrest or death in the family
- Level of hematocrit that is below 30.
- Shortness of breath
- Medical history of anemia
Diagnosis of Syncope
- Laboratory Testing such as blood tests. Blood tests are used to screen for anemia or metabolic abnormalities.
- Electrocardiogram (EKG or ECG). ECG is a diagnostic procedure that analyzes the heart’s electrical activity. Electrodes (tiny adhesive patches) are put to the skin to detect insufficient blood supply to the heart muscle (ischemia), heart anomalies such as heart chamber hypertrophy, aberrant electrical conduction, and to evaluate heart rhythm.
- Exercise Stress Test. A non-imaging exercise stress test may determine and validate arrhythmias or atrial and ventricular blockage as the cause of syncope. MPI stress testing may not be required, but an evaluation of underlying acute coronary syndrome may be advantageous.
- Echocardiography. Echocardiography is beneficial for risk stratification because it measures left ventricular function, indicating arrhythmias in patients with idiopathic syncope, cardiac history, or an aberrant ECG. It can also diagnose severe aortic stenosis in patients who exhibit suspicious signs or symptoms.
- Ambulatory Cardiac Monitoring. Ambulatory cardiac monitoring has proven to be an effective tool for determining the cause of presyncope or syncope. The degree of probability of cardiac arrhythmias, the incidence, and form of symptoms, and the diagnostic value of the monitoring system all influence the selection of ambulatory monitoring modality.
- Head-up tilt testing (HTT). Head-up tilt testing (HTT) is now routinely used to study syncope and presyncope that are otherwise inexplicable. This diagnostic test has also been used to diagnose neurologically caused syncope for over 20 years, although its specific involvement in the clinical diagnosis is still unknown.
- Blood Volume Determination. Measuring blood volume may help clarify the mechanisms of syncope in the specific patient and aid in identifying the best course of treatment.
- Hemodynamic Monitoring. A hemodynamic test is a nuclear imaging treatment used to diagnose syncope and other circulatory problems. When the cardiac muscle relaxes and pumps blood throughout the body, this test controls the blood flow and pressure inside the blood arteries.
- Autonomic Reflex Testing. Autonomic reflex testing involves several tests that measure blood pressure, blood circulation, heartbeat, body temperature, and perspiration in response to various stimuli. These measurements can assist the medical practitioner in determining whether or not the autonomic nervous system is functioning regularly or whether there is permanent nerve damage.
Treatment for Syncope
Syncope treatment will vary depending on the underlying illness but may include:
- Catheter ablation. Catheter ablation is a treatment that uses a catheter to perforate the precise cardiac cells that cause irregular heart rhythms.
- Pacemakers. Pacemakers are devices implanted beneath the skin underneath the collarbone to administer periodic electric currents to the heart via tiny, very resistant wires. It is also used to manage bradycardia, heart block, and some types of cardiovascular disease.
- Implantable Cardioverter-Defibrillators. ICDs are small implanted devices that give an electrical pulse to the heart to reset a dangerously erratic heartbeat; they are commonly used to treat ventricular tachycardia or heart failure.
- Keeping away from known triggers
- Wear compression stockings or support undergarments to promote blood circulation.
- Making dietary modifications. The doctor may advise the patient to eat small, frequent meals, consume more salt (sodium), drink more fluids, boost potassium intake, and avoid coffee and alcohol.
- When standing up, be extremely cautious. While sleeping, elevate the head of the bed. This approach can be accomplished by adding additional pillows or installing risers beneath the legs of the edge of the bed.
Nursing Considerations for Syncope
- The nurse must obtain a comprehensive history. Determine whether the patient has a history of syncopal episodes. Inquire if there is a family heart condition disease, sudden cardiac arrest, or neurological illness. A detailed history, medical examination, and diagnostic testing can usually reveal cardiac structural reasons for syncope.
- Ask about the background of the incident, including any warning indications. Palpitations, effort, fatigue, vertigo, or other tachyarrhythmia signs are frequently associated with cardiac-related syncope. If the experience was not witnessed, try to rule out related occurrences such as dizziness, vertigo, a “drop attack,” and seizure.
- Explain the etiology, treatment, and prescribed medications if the patient has a recent syncopal episode or has a history of similar events. After experiencing an incident of noncardiac syncope, teach the patient the significance of identifying early warnings such as dizziness, pale complexion, and nausea. To help prevent unconsciousness, instruct the patient to rest at the first symptom of dizziness. In the case of vasovagal syncope, tell him or her to elevate the legs to increase blood supply to the brain.
Nursing Diagnosis for Syncope
Syncope Nursing Care Plan 1
Risk for Fall
Nursing Diagnosis: Risk for Fall related to sudden decrease of blood pressure secondary to syncope
Desired Outcome: The patient will describe his or her intention to employ safety precautions to avoid falls and exhibit targeted prevention actions.
|Syncope Nursing Interventions||Rationale|
|Develop a personalized plan of care for patients with a history of syncope to ensure the safety of patients and avoid risks of falls. Equip a treatment plan that is tailored to the patient’s distinctive needs.||A diverse strategy is required to plan a personalized fall prevention program for nursing care in every healthcare setting. Avoid depending too heavily on general fall prevention because everyone’s demands are different. All patients are subjected to standard fall precautions to limit their risk of falling. These standard tactics help create a safe environment that lowers accidental falls and defines essential prevention measures for all patients.|
|Patients with a history of syncope should be given signs or secure wristband identification since they are in danger of falling. As a result, it encourages healthcare providers to practice fall prevention measures.||Signs or secure wristbands are critical for patients who are in danger of falling. Healthcare practitioners must recognize who is at risk for falls since they are accountable for increasing patient security and avoiding accidents.|
|Beds should be placed at the lowest potential position. If necessary, place the patient’s sleeping surface as close to the floor as reasonable.||Bringing the beds closer to the floor diminishes the danger of falls and significant harm. In some hospital settings, placing the mattress on the floor minimizes the extreme danger of a fall. Low beds are intended to reduce the distance a patient falls after getting out of bed. Although these beds can not prevent falls, they shorten the distance between falls, minimizing trauma and injury.|
|Regularly monitor the vital signs of patients with a history of syncope and keep an eye out for signs of dizziness.||Monitoring vital signs is an effective intervention for both hypotension and syncope. Early detection of dizziness may reduce the risk of falling.|
|Provide adequate lighting in the room, especially in the evening.||Patients, particularly older adults, are more prone to experience syncope; since they also have diminished visual ability, illuminating an unfamiliar location helps boost vision if the patient needs to get up in the middle of the night. According to some research, households with appropriate lighting have fewer falls. Home light improvements may minimize the number of falls among older persons.|
Syncope Nursing Care Plan 2
Desired Outcome: The patient will notice a reduction in the intensity or complete eradication of nausea.
|Syncope Nursing Interventions||Rationale|
|Identify different possible causes of the patient’s nausea.||The assessment of the patient’s reasons for nausea will determine the choice of therapies to be implemented. If the stimulus is removed, treatment may not be required. This intervention will also help the healthcare practitioner assess whether nausea may lead to syncope.|
|Analyze the following nausea characteristics: HistoryDurationFrequencyIntensityRisk factorsPrescribed medicationsMeasures that are taken to deal with the health condition||Comprehensive monitoring and assessment of nausea can aid in determining actions to alleviate the problem and prevent syncope.|
|Allow the patient to utilize alternative treatment nausea management approaches such as relaxation, guided visualization, music therapy, diversion, or deep breathing techniques.||These approaches have assisted people in resolving the condition, but they must be used before it emerges. This method may help to alleviate nausea and minimize syncope.|
|If the patient has a history of syncope episodes, keep the surroundings well-ventilated and assist him or her in getting some clean air outdoors.||A very well-ventilated room or having a fan nearby facilitates respiration and reduces the incidence of syncope episodes.|
|Teach the patient the importance of taking prescription drugs exactly as prescribed.||Being compliant with the prescribed medications lowers occurrences of nausea and syncope.|
|Teach the patient the value of switching positions carefully and gently.||Sudden or abrupt movements might increase nausea and cause unexpected syncope. That is why it is critical to alter positions slowly; significantly when changing positions from supine to upright.|
Syncope Nursing Care Plan 3
Risk for Injury
Nursing Diagnosis: Risk for Injury related to brain hypoxia secondary to syncope as evidenced by dizziness, sweating, and fatigue.
Desired Outcome: Within a few hours of nursing intervention and treatment, the patient will identify the elements that enhance their risk of injury and will display harm-avoidance practices and behaviors.
|Syncope Nursing Interventions||Rationale|
|Help the patient become aware of their surroundings, especially if they are prone to syncope episodes. Place the call light within their reach and educate them on how to call for help.||The patient should be familiar with the area’s layout to avoid accidents and injuries. Items that are too far away from the patient may impose a risk.|
|Request the family members or significant others to accompany the patient to reduce the likelihood of an accidental fall or unexpected loss of consciousness.||This intervention protects the patient from inadvertent damage, such as falling or saving from unexpected syncope’s severe effects. Parents, family members, and significant others of hospitalized patients have an essential role in maintaining their safety and shielding them from risks of injury.|
|Develop or obey agency protocols for appropriately identifying patients with a history of syncope.||To confirm the patient’s identity before hospitalization or transfer and before administering drugs, blood products, or nursing care, use at least two identifiers: name, date of birth, allocated identification number, or phone number. This method will enhance the patient’s identification system’s dependability and reduce nursing errors. Thus, it will safeguard the safety of all patients, especially those who are unable to communicate verbally (e.g., infants, unconscious, or disorganized patients).|
|Perform a safety evaluation in the patient’s residence or inpatient environment, especially if the patient has episodes of syncope regularly.||Nurses conduct an environmental risk assessment to evaluate the existence of objects or things (such as cords and hooks) that could cause significant harm. As a result, it must be eliminated to safeguard patients’ safety.|
|Placing the patient in a room near the nurses’ station is a good idea.||Moving the patient’s room closest to the nurse station enables the healthcare professionals to monitor the patients at greater risk of injury and falls and provide interventions as soon as possible.|
Syncope Nursing Care Plan 4
Nursing Diagnosis: Activity Intolerance related to shortness of breath during or after performing daily activities secondary to syncope as evidenced by weakness throughout the body and extreme discomfort when performing Activities of Daily Living (ADLs).
Desired Outcome: The patient will be able to undertake activities of daily living (ADLs) with increased capacity and enthusiasm.
|Syncope Nursing Interventions||Rationale|
|Allow the patient to conduct the activity more carefully, over a more extended period, with more relaxation or breaks, or provide assistance if required, especially if he has a history of syncope.||This intervention aids in improving tolerance for daily activities.|
|Assist the patient with activities of daily living while minimizing patient reliance.||Supporting the patient with ADLs allows for conserving energy. Additionally, enabling progressive endurance will improve the patient’s tolerance and self-esteem.|
|Monitor and evaluate the patient’s sleep pattern and the amount of sleep he or she has gotten in the last few days.||Sleep deprivation and trouble sleeping can impair the patient’s activity level and increase the probability of syncopal episodes — these must be managed before successful activity progression can be accomplished.|
|Teach the patient and family members how to acknowledge physical overexertion or over activity indicators.||Knowledge raises awareness, which helps to avoid the complications of overexertion. Overexertion can also cause syncope, which is why it is crucial to understand the symptoms of fatigue.|
|Educate the patient to schedule activities for when they have the most stamina.||Activities should be scheduled in advance to correspond with the patient’s highest energy level. If the patient does not have enough strength to go about his regular duties, suggest that he take a break. This strategy will assist the patient in avoiding overexertion.|
Syncope Nursing Care Plan 5
Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with the information about the health condition secondary to syncope as evidenced by lack of capacity to prevent aggravation of complications of the disorder.
Desired Outcome: The patient will be knowledgeable about the condition and learn to prevent severe complications from emerging.
|Syncope Nursing Interventions||Rationale|
|Provide the patient with physical comfort.||According to Maslow’s hierarchy of requirements, basic physiological demands must be met before patient education can begin. Assuring the patient’s bodily comfort allows them to focus and comprehend syncope. He will determine ways to reduce the likelihood of syncopal events.|
|Include the patient in developing the syncope teaching regimen, beginning with identifying learning goals and strategies at the start of the session.||Setting goals informs the patient about what will be discussed and what is anticipated throughout the session. This intervention will increase the patient’s knowledge of syncope and its management.|
|Assess the patient’s priorities.||Allowing the patient to choose the most critical content to be provided first is the most effective method. In line with the patient’s condition, he must first know the causes of syncope before discussing the following topics.|
|Involve the patient in developing particular outcomes for the teaching session, such as determining what is most important to learn from their point of view and lifestyle.||Patient involvement enhances adherence to health regimens and turns teaching and learning into a collaborative effort.|
|Encourage patients to inquire about syncope, its causes, and its complications.||Questions allow for accessible communication between healthcare providers and patients and confirmation of comprehension of supplied information about syncope.|
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Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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