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Nursing Diagnosis and Interventions for Syncope- A Student’s Guide

Nursing Diagnosis for Syncope

Introduction

Syncope is the medical word for passing out or fainting. It’s caused by a temporary decrease in blood supply to the brain.

Syncope can occur if your blood pressure drops suddenly, your heart rate drops, or the amount of blood in different parts of your body fluctuates. If you pass out, you’ll most likely wake up cognizant and alert soon after, but you might be disoriented for a while.

It is characterized by an abrupt loss of awareness and muscular tone caused by a transient lack of blood flow to the brain. Low blood pressure, dehydration, or rising too rapidly from a sitting or lying down position can contribute to the illness.

This blog post discusses various nursing diagnoses, causes, symptoms, preventions, care plans and interventions for syncope. As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Types of Syncope

Syncope can take several forms. What type a person has is determined by the cause of the issue.

Vasovagal Syncope (Cardio-neurogenic Syncope)

Vasovagal syncope is the most common type of syncope. It is caused by a sudden drop in blood pressure, which causes a decrease in blood flow to the brain. When you stand up, gravity causes blood to settle in the lower part of your body, below your diaphragm. When that happens, the heart and autonomic nervous system (ANS) work to keep your blood pressure stable.

Some patients with vasovagal syncope have a condition called orthostatic hypotension. This condition keeps the blood vessels from getting smaller (as they should) when the patient stands. This causes blood to collect in the legs and leads to a quick drop in blood pressure.

Situational syncope

Situational syncope is a type of vasovagal syncope. It happens only during certain situations that affect the nervous system and lead to syncope. Some of these situations are:

  1. Dehydration
  2. Intense emotional stress
  3. Anxiety
  4. Fear
  5. Pain
  6. Hunger
  7. Use of alcohol or drugs
  8. Hyperventilation (breathing in too much oxygen and getting rid of too much carbon dioxide too quickly)
  9. Coughing forcefully, turning the neck, or wearing a tight collar (carotid sinus hypersensitivity)

Postural syncope (Postural Hypotension)

Postural syncope is caused by a sudden drop in blood pressure due to a quick change in position, such as lying down to standing. Certain medications and dehydration can lead to this condition. Patients with this type of syncope usually have changes in their blood pressure that cause it to drop by at least 20 mmHg (systolic/top number) and at least ten mmHg (diastolic/bottom number) when they stand.

Cardiac syncope is caused by a heart or blood vessel condition that affects blood flow to the brain. These conditions can include an abnormal heart rhythm (arrhythmia), obstructed blood flow in the heart due to structural heart disease (the way the heart is formed), blockage in the cardiac blood vessels (myocardial ischemia), valve disease, aortic stenosis, blood clot, or heart failure. If you have cardiac syncope, it is essential to see a cardiologist for proper treatment.

Neurologic Syncope

Neurologic syncope is caused by a neurological condition such as seizure, stroke, or transient ischemic attack (TIA). Other less common conditions that lead to neurologic syncope include migraines and normal pressure hydrocephalus.

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural-Orthostatic Tachycardia Syndrome is caused by a fast heart rate (tachycardia) that happens when a person stands after sitting or lying down. The heart rate can speed up by 30 beats per minute or more. The increase usually happens within 10 minutes of standing. The condition is most common in women, but it can also occur in men.

Symptoms of Syncope

The most common symptoms of syncope include:

  • Blacking out
  • Feeling lightheaded
  • Falling for no reason
  • Feeling dizzy
  • Feeling tired or dizzy
  • Fainting, especially after eating or exercising
  • Feeling unsteady or weak when standing
  • Changes in vision, such as seeing spots or having tunnel vision
  • Headaches

Many times, patients feel an episode of syncope coming on. They have what are called “premonitory symptoms,” such as feeling lightheaded, nauseous, and heart palpitations (irregular heartbeats that feel like “fluttering” in the chest). If you have syncope, you will likely be able to keep from fainting if you sit or lie down and put your legs up if you feel these symptoms.

Syncope can be a sign of a more severe condition. So, it is essential to get treatment right away after you have an episode of syncope. Most patients can prevent problems with syncope once they get an accurate diagnosis and proper treatment.

Causes Syncope

Syncope is a symptom that various illnesses can cause, ranging from benign to life-threatening. Syncope can be caused by a variety of non-life-threatening reasons such as overheating, dehydration, intense sweating, tiredness, or blood pooling in the legs owing to fast changes in body position. It’s critical to figure out what’s causing your syncope and whether you have any underlying issues.

Syncope can also be caused by significant heart disorders such as bradycardia, tachycardia, or blood flow restriction.

How is syncope diagnosed?

If you have syncope, you should see your doctor, who can refer you to a syncope specialist for a complete evaluation.

The evaluation begins with a careful review of your medical history and a physical exam. Your doctor will ask you detailed questions about your symptoms and syncope episodes, including whether you have any symptoms before you faint and when and where the attacks happen.

You may then have one or more tests to help your doctor determine the cause of your syncope. These tests check things like the condition of your heart, how fast your heart is beating (heart rate), the amount of blood in your body (blood volume), and blood flow in different positions.

Tests to determine causes of syncope include:

Laboratory testing: Blood work to check for anemia or metabolic changes.

Electrocardiogram (EKG or ECG): A test that records the electrical activity of your heart. Electrodes (small sticky patches) are applied to your skin to collect this information.

Exercise stress test: A test that uses an ECG to record your heart’s electrical activity while you are active. This is done on a treadmill or stationary bike, which helps you reach a target heart rate.

Ambulatory monitor: You will wear a monitor that uses electrodes to record information about your heart’s rate and rhythm.

Echocardiogram: A test that uses high-frequency sound waves to create an image of the heart structures.

Tilt table (head-up tilt test): A test that records your blood pressure and heart rate on a minute-by-minute or beat-by-beat basis while the table is tilted to different levels as you stay head-up. The test can show abnormal cardiovascular reflexes that cause syncope.

Blood volume determination: A test to see if you have the right amount of blood in your body, based on your gender, height, and weight. A small amount of a radioactive substance (tracer) is injected through an intravenous (IV) line placed in a vein in your arm. Blood samples are then taken and analyzed. The blood volume analyzer system used at Cleveland Clinic can provide accurate test results within 35 minutes.

Hemodynamic testing: A test to check the blood flow and pressure inside your blood vessels when your heart muscle contracts and pumps blood throughout the body. A small amount of a radioactive substance (tracer) is injected through an intravenous (IV) line placed in a vein in your arm, and three sets of images are taken.

Autonomic reflex testing: A series of different tests are done to monitor blood pressure, blood flow, heart rate, skin temperature, and sweating in response to certain stimuli. These measurements can help your doctor determine if your autonomic nervous system is usually working or if there is nerve damage.

 Nursing Diagnoses Associated with Syncope

The following is a list of possible diagnoses that may be given to patients who have this condition;    

  • Activity intolerance .
  • Anxiety/fear-related behaviors that may include panic attack with a syncopal episode (PAS).
  • Blurred vision.
  • Dizziness/lightheadedness.
  • Imbalanced nutrition: less than body requirements.
  • Impaired gas exchange related to ventilation/perfusion imbalance.
  • Deficient fluid volume related to inadequate intake or excessive losses.
  • Neurogenic bladder due to interruption in the spinal reflex arc.
  • Anxiety/fear-related behaviors that may include panic attack with a syncopal episode (PAS).
  • Decreased cerebral perfusion resulting from anxiety reactions (CAN).
  • Constipation (IC) that may include anorexia, nausea, or vomiting (ANV).
  • Nausea and Vomiting related to anxiety.
  • Constipation resulting from immobility which may cause decreased activity tolerance (IAT).

Syncope Treatment Options

Your treatment options will depend on what is causing your syncope and the results of your evaluation and testing. The goal of treatment is to keep you from having episodes of syncope.

Treatment options include:

  • Taking medications or making changes to medications you already take.
  • Wearing support garments or compression stockings to improve blood circulation.
  • Making changes to your diet. Your doctor may suggest that you eat small, frequent meals; eat more salt (sodium); drink more fluids, increase the amount of potassium in your diet, and avoid caffeine and alcohol.
  • Be extra cautious when you stand up.
  • Elevating the head of your bed while sleeping. You can do this by using extra pillows or by placing risers under the legs of the head of the bed.
  • Avoiding or changing the situations or “triggers” that cause a syncope episode.
  • Biofeedback training to control a fast heartbeat.
  • Treatment for structural heart disease.
  • Implanting a pacemaker to keep your heart rate regular (only needed for patients with certain medical conditions).
  • An implantable cardiac defibrillator (ICD). This device constantly monitors your heart rate and rhythm and corrects a fast, abnormal rhythm (only needed for patients with certain medical conditions).

Syncope Nursing Care Plan

Goals and Outcomes

The individual will relate controlled falls or no falls, as evidenced by the following indicators:

  1. A patient will not sustain a fall.
  2. A patient will relate the intent to use safety measures to prevent falls.
  3. A patient will demonstrate selective prevention measures.
  4. Patients and caregivers will implement strategies to increase safety and prevent falls in the home.

Nursing Assessment

Falls are due to several factors, and a holistic approach to the individual and environment is important. If a person is considered at high risk for falls after the screening, a health professional should conduct a falls risk assessment to obtain a more detailed analysis of the individual’s risk of falling. A fall risk assessment requires using a validated tool that has been examined by researchers to be useful in naming the causes of falls in an individual. As a person’s health and circumstances change, reassessment is required.

AssessmentRationales
Assess for circumstances associated with increasing the level of fall risk upon admission, following any alteration in the patient’s physical condition or cognitive status, whenever a fall happens, systematically during a hospital stay, or at defined times in long-term care settings:Using standard assessment tools, the level of risk and subsequent fall precautions can be determined. These tools incorporate intrinsic and extrinsic factors.
History of fallsAn individual is more likely to fall again if they have sustained one or more falls in the past six months.
Mental status changesConfusion and impaired judgment increase the patient’s chance of falling.
Age-related physical changesOlder people with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance. These changes include reduced visual function, impaired color perception, change in center of gravity, unsteady gait, decreased muscle strength, decreased endurance, altered depth perception, and delayed response and reaction times.
Sensory deficitsVision and hearing impairment limit the patient’s ability to perceive hazards in the surroundings.
Balance and gaitOlder adults who have poor balance or difficulty walking are more likely than others to fall. These problems may be associated with lack of exercise or a neurological cause, arthritis, or other medical conditions and their treatments.
Use of mobility assistive devicesInappropriate use and maintenance of mobility aids such as canes, walkers, and wheelchairs increase the patient’s risk for falls.
Disease-related symptomsIncreased incidence of falls has been demonstrated in people with symptoms such as orthostatic hypotensionurinary incontinence, reduced cerebral blood flow, edema, dizziness, weakness, fatigue, and confusion.
MedicationsRisk factors for falls also include the use of medications such as antihypertensive agents, ACE-inhibitors, diureticstricyclic antidepressants, alcohol use, antianxiety agents, opiates, and hypnotics or tranquilizers. Drugs that affect BP and level of consciousness are associated with the highest fall risk.
Unsafe clothingPersonal and situational factors such as poor-fitting shoes, long robes, or long pants legs can limit a person’s ambulation and increase fall risk.
Assess the patient’s environment for factors known to increase fall risks, such as unfamiliar settings, inadequate lighting, wet surfaces, waxed floors, clutter, and objects on the floor.A fall is more likely to be experienced by an individual if the surrounding is not familiar such as the placement of furniture and equipment in a certain area.
Refer the patient with musculoskeletal problems for diagnostic evaluation.Patients with musculoskeletal problems such as osteoporosis are at increased risk for serious injury from falls. Bone mineral density testing will help identify the risk for fractures from falls. Physical therapy evaluation can identify problems with balance and gait that can increase a person’s fall risk.

Nursing Interventions

The following are the therapeutic nursing interventions for Risk for Falls:

InterventionsRationales
For patients at risk for falls, provide signs or secure a wristband identification to remind healthcare providers to implement fall precaution behaviors.Signs are vital for patients at risk for falls. Healthcare providers need to acknowledge who has the condition, for they are responsible for implementing actions to promote patient safety and prevent falls.
Transfer the patient to a room near the nurses’ station.The nearby location provides more constant observation and quick response to call needs.
Move items used by the patient within easy reaches, such as call light, urinal, water, and telephone.Items that are too far from the patient may cause a hazard and can contribute to falls.
Respond to call light as soon as possible.This is to prevent the patient from going out of bed without any assistance.
See to it that the beds are at the lowest possible position. If needed, set the patient’s sleeping surface as adjacent to the floor as possible.Keeping the beds closer to the floor reduces the risk of falls and serious injury. In some healthcare settings, placing the mattress on the floor significantly reduces fall risk.
Use side rails on beds, as needed. For beds with split side rails, leave at least one of the rails at the foot of the bed down.According to research, a disoriented or confused patient is less likely to fall when one of the four rails is left down.
Avoid the use of restraints to reduce falls.Studies demonstrate that regular use of restraints does not reduce the incidence of falls.
Guarantee appropriate room lighting, especially during the night.Patients, especially older adults, have reduced visual capacity. Lighting an unfamiliar environment helps increase visibility if the patient must get up at night.
Encourage the patient to don shoes or slippers with nonskid soles when walking.Nonskid footwear provides sure footing for the patient with diminished foot and toes lift when walking.
Familiarize the patient with the layout of the room. Limit rearranging the furniture in the room.The patient must get used to the layout of the room to avoid tripping over furniture.
Provide heavy furniture that will not tip over when used as support when the patient is ambulating. Make the primary path clear and as straight as possible. Avoid clutter on the floor surface.Patients having difficulty in balancing are not skilled at walking around certain objects that obstruct a straight path.
Bed and chair alarms must be secured when a patient gets up without support or assistance.Audible alarms can remind the patient not to get up alone. The use of alarms can be a substitute for physical restraints.
Provide the patient with a chair that has a firm seat and arms on both sides. Consider locked wheels as appropriate.When the patient experiences weakness and impaired balance, this chair style will be useful and easier to get out of.
Collude with other health care team members to assess and evaluate patients’ medications that contribute to falling. Examine peak effects for prescribed medications that affect the level of consciousness.A review of the patient’s medications by the prescribing health care provider and the pharmacist can identify side effects and drug interactions that increase the patient’s fall risk. The more medications a patient takes, the greater the risk for side effects and interactions such as dizziness, orthostatic hypotension, drowsiness, and incontinence. Polypharmacy in older adults is a significant risk factor for falls.
Consider using sitters for patients with impaired ability to follow directions which are at risk for falls.Sitters are effective for guaranteeing a secure, protected, and safe environment.
Allow the patient to participate in a program of regular exercise and gait training.Studies recommend exercises to strengthen the muscles, improve balance, and increase bone density. Increased physical conditioning reduces the risk for falls and limits injury that is sustained when a fall transpires.
Inform the patient of the advantage of wearing eyeglasses and hearing aids and to have these checked regularly.Hazard can be reduced if the patient uses appropriate aids to promote visual and auditory orientation to the environment. Visual impairment can greatly cause falls.
Consider physical and occupational therapy sessions to assist with gait techniques and provide the patient with assistive devices for transfer and ambulation. Initiate home safety evaluation as needed.The use of gait belts by all health care providers can promote safety when assisting patients with transfers from bed to chair. Assistive aids such as canes, walkers, and wheelchairs can provide the patient with improved stability and balance when ambulating. Raised toilet seats can facilitate safe transfer on and off the toilet.
Provide high-risk patients with a hip pad.These pads, when properly worn, may reduce a hip fracture when a fall happens.
If the patient has a new onset of confusion (delirium), provide reality orientation when interacting. Have family bring in familiar items, clocks, and watches from home to maintain orientation.Reality orientation can help prevent or decrease the confusion that increases the risk of falling for clients with delirium.
Ask the family to stay with the patient.This is to prevent the patient from accidentally falling or pulling out tubes.
Avoid the use of wheelchairs as much as possible because they can serve as a restraint device.Most people in wheelchairs do not move. Wheelchairs, unfortunately, serve as a restraint device.
Improve home supports.Many community service organizations provide financial assistance to make older adults make safe environments in their homes.
Teach the client how to safely ambulate at home, including using safety measures such as handrails in the bathroom.This will help relieve anxiety at home and eventually decreases the risk of falls during ambulation.

Summary

Syncope is a loss of awareness and muscle tone that occurs suddenly. This can be caused by a lack of blood supply to the brain or a problem with heart function, but it can also be caused by other factors, including emotional stress. The nurse should enquire about the patient’s medical history, current medications, allergies, and family history to see whether there are any risk factors connected with this diagnosis.

Based on the diagnosis, the nurse should create a nursing care plan. It should entail measuring the level of consciousness, skin coloration, and response time from when they are aroused back into consciousness, as well as monitoring vital signs, including pulse rate and blood pressure. They should also look for syncope-related injuries.

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