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.
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
- Tilt table test
- Electrophysiology study
- Holter monitor
The 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 Related to Syncope
Risk for Injury Care Plan
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
- Altered psychomotor performance
- A sudden decrease in blood pressure
- Decreased blood flow to the brain
- Disease processes
- Transient loss of consciousness
- Altered sensory perception
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet and nursing interventions are directed at the prevention of symptoms.
- The patient will verbalize an understanding of risks and demonstrate precautions to avoid falls or injuries
- The patient will remain free of injury
Risk for 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.
Risk for Injury 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.
Anxiety Care Plan
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
- 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
- The patient will demonstrate techniques that help reduce anxiety
- The patient will report a reduced sense of anxiety and control over syncope
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.
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 Care Plan
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
- 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
- The patient will verbalize understanding of the disease process and appropriate interventions
- The patient will participate in tests to further investigate syncope
Deficient Knowledge 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.
Deficient Knowledge 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.
References and Sources
- 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