Syncope is referred to as a brief lapse in consciousness causing fainting which is related to insufficient blood flow to the brain. Syncope is not usually a cause for concern but can be a warning sign for other illnesses.
In this article:
- Overview
- Nursing Process
- Nursing Care Plans
- Deficient Knowledge
- Risk for Adult Falls
- Risk for Injury
- Risk for Unstable Blood Pressure
Overview
Common causes of syncope include the following:
- Cardiac Syncope – If syncope occurs frequently and suddenly it may be related to cardiac issues such as aortic dissection, arrhythmia, or aortic valve stenosis.
- Reflex Syncope – This condition is caused by a trigger that slows the heart or dilates the blood vessels, causing blood pressure to drop and decreasing blood flow to the brain.
- Vasovagal Syncope – This is the most common type of reflex syncope and is triggered by dehydration, sudden change to an upright position, and emotions.
- Situational Syncope – This type of reflex syncope occurs with coughing, chest pressure after exercise, and straining with defecation.
- Carotid Sinus Syncope – Syncope can occur when there is pressure applied to the carotid artery like a tight collar or hand pressure.
- Orthostatic Hypotension – This condition occurs because of low blood pressure when standing up, causing decreased blood flow to the brain.
Syncope can be benign or a symptom of an underlying health condition. It is critical to identify the cause of syncope to initiate appropriate and timely interventions. Diagnostic tests may be ordered including:
- Electrocardiogram (ECG)
- Exercise stress test
- Echocardiogram
- Tilt table test
- Electrophysiology study
- Holter monitor
Nursing Process
Identification and treatment of the underlying condition, reducing risk for injuries, and prevention of complications are the primary goals in the management of syncope. Nurses play an essential role in all phases of the treatment regimen for patients with syncope as they are responsible for the identification of at-risk patients through obtaining a comprehensive history as well as preparing for testing and preventing falls and complications.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for syncope, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for syncope.
Anxiety
Patients who have known episodes of syncope are often stressed and anxious about the recurrence of the attacks. Safety precautions must be initiated along with interventions that can help reduce episodes.
Nursing Diagnosis: Anxiety
Related to:
- Stressors
- Unfamiliar situations
- Recurrence of syncope episodes
- Risk of injury/falls
- Strong emotions
As evidenced by:
- Expresses anxiety about life event changes
- Expresses distress
- Expresses insecurity
- Expresses helplessness
Expected Outcomes:
- Patient will demonstrate techniques that help reduce anxiety.
- Patient will report a reduced sense of anxiety and control over syncope.
Assessment:
1. Assess the patient’s anxiety levels.
Anxiety can affect the patient’s functional ability along with adherence to treatment regimens. Assess if anxiety is preventing the patient from usual activities.
2. Assess current coping techniques.
Assessing how the patient is currently coping with anxiety related to syncope can help the nurse understand what may or may not help.
Interventions:
1. Allow the patient to verbalize feelings and emotions.
Establish trust and build a rapport so the patient feels comfortable discussing their anxiety.
2. Explain all procedures and interventions.
Investigating syncope can provide answers to prevent further occurrences. Prepare the client for tests such as stress tests, tilt table tests, and wearing a Holter monitor.
3. Help the patient feel in control.
Losing consciousness can be frightening, especially if the patient sustained an injury from a past episode. Help the patient gain control of syncope by arming them with information about the types, triggers, and treatments.
4. Educate on recognizing symptoms.
Not all patients will have pre-syncopal symptoms, but instruct the patient that if they feel dizzy, light-headed, diaphoretic, or nauseous, that fainting could occur and they should prepare by sitting down or alerting someone.
Deficient Knowledge
Syncope may not always have a cause and may only occur once, but patient education is important to understand the condition and to be alert for possible underlying causes.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate information
- Inadequate interest in learning
- Inadequate participation in care planning
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about a topic
- Recurring syncopal episodes
Expected Outcomes:
- Patient will verbalize understanding of the disease process and appropriate interventions.
- Patient will participate in tests to further investigate syncope.
Assessment:
1. Assess the patient’s ability and readiness to learn.
The patient’s ability to comprehend and readiness to learn can contribute to the success or failure of patient education.
2. Assess for a support system.
Family members may also need to be educated on recognizing and intervening if pre-syncopal symptoms occur or what to do when the patient faints.
Interventions:
1. Take precautions with medications.
Diuretics and antihypertensives can cause dehydration or worsen orthostatic hypotension. Ensure the patient understands the side effects of their medications.
2. Teach to prevent vasovagal responses.
Since vasovagal syncope is the most common type of syncope, educate the patient on avoiding triggers such as the sight of blood, standing up too quickly, standing too long, and intense fear or stress.
3. Document syncopal episodes to learn more.
If syncope is recurring, have the patient or family member document events surrounding the episode, where it occurred, the time of day, how long it lasted, and how the patient felt afterward. This information can identify triggers or underlying conditions.
4. Follow-up with providers.
Instruct the patient to adhere to discharge instructions such as following up with a cardiologist if syncope is suspected to be related to a cardiac event.
Risk for Adult Falls
Syncope is a condition characterized by a brief lapse in consciousness with loss of postural tone or fainting, increasing the patient’s risk for falls.
Nursing Diagnosis: Risk for (Adult) Falls
Related to:
- Disease process
- Age > 65
- Loss of consciousness
- Fainting
- Impaired postural balance
- Hypotension
- Hypoglycemia
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will remain free from falls and other related injuries.
- Patient will demonstrate interventions that can help reduce the risk of falls.
Assessment:
1. Assess and monitor the patient’s vital signs.
Various alterations in the patient’s vital signs can precipitate syncope. Hypotension is a common cause. The nurse can also assess the patient’s pulse for irregularities, as arrhythmias are another cause.
2. Complete a fall risk assessment.
Other than syncope, the adult should be assessed for other risk factors for falls, such as a history of falling, altered mental status, poor mobility, vision abnormalities, and other medical conditions.
3. Conduct a meticulous history and physical examination.
This can help determine the cause of syncope and plan appropriate treatment regimens to manage the patient’s condition, reduce risks, and prevent complications. Causes may include vasovagal triggers, cardiovascular problems, hypoglycemia, and more.
Interventions:
1. Instruct the patient to wear an identification band.
Wearing an identification wristband is vital for patients at risk for falling due to syncope, as these wristbands can make it easier for healthcare practitioners to provide appropriate aid quickly.
2. Instruct on changing positions slowly.
Hypotension is a common cause of syncope. When the patient moves from lying to sitting or sitting to standing, ensure they do so slowly, allowing the body to adjust to the change in blood pressure.
3. Educate the patient and family about syncope.
Offer education to help the patient and family understand triggers or underlying causes of syncope and initiate appropriate interventions to reduce the risk of injuries and falls at home.
4. Initiate fall precaution interventions.
Fall precautions like bed alarms, keeping the bed in the lowest position, and utilizing assistive devices can help reduce falls during a syncopal episode.
5. Remove potential environmental hazards.
Environmental hazards, including clutter, floor coverings, and cords, can predispose patients with syncope to potential injuries and falls.
Risk for Injury
Syncope can occur suddenly with or without warning. Patients suffering from syncope have an increased risk of injury and falls.
Nursing Diagnosis: Risk for Injury
Related to:
- Altered psychomotor performance
- A sudden decrease in blood pressure
- Decreased blood flow to the brain
- Disease processes
- Transient loss of consciousness
- Falls
- Altered sensory perception
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected Outcomes:
- Patient will verbalize an understanding of risks and demonstrate precautions to avoid falls or injuries.
- Patient will remain free of injury.
Assessment:
1. Assess the causative factor of syncope.
Syncope can be benign or a symptom of an underlying health condition. Identifying a possible causative factor can direct treatment and prevent further episodes.
2. Assess the history of syncope and possible triggers.
Assess how frequently episodes of syncope or dizziness occur to determine possible triggers.
Interventions:
1. Ensure safety precautions are always in place.
Safety precautions like keeping side rails up and keeping the bed in the lowest position with the call bell within reach will help reduce falls.
2. Remove risks from the home environment.
Reduce the risk of injury and falls by not navigating stairs and using assistive devices.
3. Institute alert devices.
Patients who experience a syncopal episode may end up falling. Ensure they can call for help by using a Life Alert bracelet/necklace or other emergency system.
4. Do not drive after syncope.
Instruct the patient not to drive or participate in risky activities such as using dangerous equipment or ladders after syncope.
Risk for Unstable Blood Pressure
The temporary drop in cerebral blood flow that occurs in syncope is frequently caused by low blood pressure.
Nursing Diagnosis: Risk for Unstable Blood Pressure
Related to:
- Disease process
- Orthostatic hypotension
- Dehydration
- Cardiac conditions
- Medication regimen
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will maintain vital signs, including blood pressure, within normal limits.
- Patient will remain free from dizziness with position changes.
Assessment:
1. Assess and monitor the patient’s blood pressure and other vital signs.
Syncope can occur when there is a significant drop in the patient’s blood pressure. This drop in blood pressure can occur from an array of causes, such as dehydration, exercise, emotions, position changes, alcohol use, and more.
2. Perform a comprehensive cardiac assessment.
Various cardiac conditions can cause unstable blood pressure and arrhythmias, leading to syncopal episodes.
3. Review current medications and their side effects.
Antihypertensives can inadvertently cause hypotension, especially if taken incorrectly. Other medications that can cause hypotension include antidepressants, nitrates, diuretics, antipsychotics, and opioids.
Interventions:
1. Assist in performing an electrocardiogram (ECG).
An ECG can help monitor the patient’s heart rhythm, detect cardiac abnormalities, and allow prompt treatment and unstable blood pressure correction.
2. Instruct on medication use.
Polypharmacy can lead to hypotension. Ensure adults are taking their medications as prescribed and are not taking duplicates of medications with the same mechanism of action. Review over-the-counter drugs and herbal remedies that may be contributing to symptoms.
3. Advise on nonpharmacologic ways to increase blood pressure.
If hypotension is a recurrent issue for the patient, advise on strategies to prevent drops in blood pressure, such as wearing compression stockings, drinking enough water, and adding salt to the diet, if advised.
4. Provide a calm and restful environment.
Stress can cause unstable blood pressure and can precipitate syncopal episodes. Maintaining a calm environment can help keep emotions controlled and prevent anxiety and fear.
5. Assist the patient in changing positions slowly.
When assisting the patient out of bed or from a chair, do so slowly, allowing the patient to sit or stand for several moments to allow the blood pressure to equalize.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Syncope. Cleveland Clinic. Updated May 14, 2019. From: https://my.clevelandclinic.org/health/diseases/17536-syncope
- Syncope (Fainting). American Heart Association. Last Reviewed: Jun 30, 2017. From: https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting
- Syncope. Grossman SA, Badireddy M. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442006/
- Syncope. Morag, MD, FACEP. The Heart.org. Medscape. Updated: Jan 13, 2017. From: https://emedicine.medscape.com/article/811669-overview
