Cardio4

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Cardio4

  1. 1. MYOCARDIAL INFARCTION
  2. 2. PATHOPHYSIOLOGY
  3. 6. RISK FACTORS
  4. 7. <ul><li>MALE </li></ul><ul><ul><li>40 years of age </li></ul></ul><ul><ul><li>with arterial HPN </li></ul></ul><ul><li>FEMALE </li></ul><ul><ul><li>taking oral contraceptives </li></ul></ul><ul><ul><li>smoking </li></ul></ul>
  5. 8. CLINICAL MANIFESTATION
  6. 9. <ul><li>CHEST PAIN </li></ul><ul><ul><li>occurs suddenly </li></ul></ul><ul><ul><li>continuous unabated </li></ul></ul><ul><ul><li>lower sternal region </li></ul></ul><ul><ul><li>upper abdomen </li></ul></ul><ul><ul><li> steadily in severity </li></ul></ul><ul><ul><li>until it becomes unbearable </li></ul></ul><ul><ul><li>heavy, “ viselike ” pain </li></ul></ul>
  7. 10. <ul><ul><li>radiate to shoulders </li></ul></ul><ul><ul><li>down the arms (Left) </li></ul></ul><ul><ul><li>jaw and neck </li></ul></ul><ul><ul><li>begins spontaneously </li></ul></ul><ul><ul><li>persists for hours or days </li></ul></ul>C:WINDOWShinhem.scr
  8. 11. <ul><ul><li>relieve neither by rest nor by nitroglycerin </li></ul></ul><ul><ul><li>accompanied by SOB, </li></ul></ul><ul><ul><li>pallor, diaphoresis, dizziness, lightheadedness, N/V </li></ul></ul>C:WINDOWShinhem.scr
  9. 12. DIAGNOSTIC EVAULATIONS
  10. 13. <ul><li>1. PATIENT HISTORY </li></ul><ul><ul><li>history of present illness </li></ul></ul><ul><ul><ul><li>diagnosis of MI </li></ul></ul></ul><ul><ul><ul><li>subjective </li></ul></ul></ul><ul><ul><li>history of present illness and family health history </li></ul></ul><ul><ul><ul><li>risk factors </li></ul></ul></ul>
  11. 14. <ul><li>2. ECG </li></ul><ul><ul><li>electrophysiology of heart </li></ul></ul><ul><ul><li>monitor evolution and resolution of MI </li></ul></ul><ul><ul><li>determine location and relative size of infarction </li></ul></ul>
  12. 15. NORMAL ECG ECG in MI
  13. 16. <ul><li>3. ECHOCARDIOGRAM </li></ul><ul><ul><li>evaluate cardiac fnx (ventricular) </li></ul></ul><ul><ul><li>ejection fraction </li></ul></ul>
  14. 17. <ul><li>4. SERUM ENZYMES AND ISOENZYMES </li></ul><ul><ul><li>CREATINE KINASE MB </li></ul></ul><ul><ul><ul><li> when there has been damage </li></ul></ul></ul><ul><ul><ul><li>cardiac-specific enzyme </li></ul></ul></ul><ul><ul><li>LACTIC DEHYDROGENASE </li></ul></ul><ul><ul><ul><li>LDH 1 and LDH 2  </li></ul></ul></ul>
  15. 18. ASSESSMENT
  16. 19. <ul><li>1. LEVEL OF CONSCIOUSNESS </li></ul><ul><ul><ul><li>Orientation </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Time </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Place </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Person </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Slurred speech </li></ul></ul></ul><ul><ul><ul><li>Deepening of snoring sounds </li></ul></ul></ul>
  17. 20. <ul><li>2. CHEST PAIN </li></ul><ul><ul><li>pain rating intensity </li></ul></ul><ul><li>3. HEART RATE </li></ul><ul><ul><li>rate </li></ul></ul><ul><ul><li>unexplained  or  </li></ul></ul>
  18. 21. <ul><li>4. HEART SOUNDS </li></ul><ul><ul><li>S1 apex; systole (lub) </li></ul></ul><ul><ul><li>S2 base; diastole (dub) </li></ul></ul>
  19. 22. <ul><ul><li>ABNORMAL HEART SOUNDS </li></ul></ul><ul><ul><li>S3 ventricular gallop </li></ul></ul><ul><ul><li>S1- S2- S3 (ken-tucck-y) </li></ul></ul><ul><ul><li>S4 atrial or presystolic gallop </li></ul></ul><ul><ul><li>S4- S1- S2 (ten-nes-see) </li></ul></ul><ul><ul><li>heart murmur </li></ul></ul><ul><ul><li>friction rub </li></ul></ul>
  20. 23. <ul><li>5. BLOOD PRESSURE </li></ul><ul><ul><li>vasodilator </li></ul></ul><ul><ul><li> BP </li></ul></ul><ul><li>6. PERIPHERAL PULSES </li></ul><ul><ul><li>blood flow to extremities </li></ul></ul><ul><li>7. IV SITES </li></ul><ul><ul><li>patency </li></ul></ul><ul><ul><li>signs of inflammation </li></ul></ul>
  21. 24. <ul><ul><li>8. SKIN COLOR AND TEMPERATURE </li></ul></ul><ul><ul><ul><li>pink, warm skin </li></ul></ul></ul><ul><ul><ul><li>blue to purple nail beds, oral mucosa, ear lobes </li></ul></ul></ul><ul><ul><ul><li>cool, moist skin </li></ul></ul></ul>
  22. 25. <ul><ul><li>9. LUNGS </li></ul></ul><ul><ul><li> or  rate of respiration </li></ul></ul><ul><ul><li>labored breathing </li></ul></ul><ul><ul><li>shortness of breath </li></ul></ul><ul><ul><li>dry, hacking cough </li></ul></ul><ul><ul><li>wheezes, crackles </li></ul></ul>
  23. 26. <ul><li>10. GI FUNCTION </li></ul><ul><ul><li>N/V </li></ul></ul><ul><ul><li>abdomen </li></ul></ul><ul><ul><ul><li>Tenderness </li></ul></ul></ul><ul><ul><ul><li>Bowel sounds </li></ul></ul></ul><ul><ul><li>occluded Mesentric Artery </li></ul></ul><ul><li>11. FLUID VOLUME STATUS </li></ul><ul><ul><li>U/O </li></ul></ul><ul><ul><li>Edema </li></ul></ul>
  24. 27. POSSIBLE NURSING DIAGNOSES
  25. 28. <ul><li>Chest Pain </li></ul><ul><li>Decreased cardiac output </li></ul><ul><li>Ineffective cardiopulmonary tissue perfusion </li></ul><ul><li>Potential impaired gas exchange </li></ul><ul><li>Potential altered peripheral tissue perfusion </li></ul><ul><li>Risk for activity intolerance </li></ul><ul><li>Anxiety </li></ul><ul><li>Deficient knowledge </li></ul>
  26. 29. PLANNING
  27. 30. <ul><li>Relief of pain or ischemic signs and symptoms </li></ul><ul><li>Prevention of further myocardial damage </li></ul><ul><li>Absence of respiratory dysfunction </li></ul><ul><li>Maintenance or attainment of adequate tissue perfusion by increasing heart’s workload </li></ul>
  28. 31. <ul><li>Reduce anxiety </li></ul><ul><li>Adherence to self-care program </li></ul><ul><li>Absence or early recognition of complications </li></ul>
  29. 32. INTERVENTIONS
  30. 33. <ul><li>Relieve chest pain </li></ul><ul><li>VASODILATORS </li></ul><ul><ul><li>IV Nitroglycerine </li></ul></ul><ul><li>ANTI-COAGULANTS </li></ul><ul><ul><li>Heparin </li></ul></ul><ul><li>THROMBOLYTICS </li></ul><ul><ul><li>Streptokinase </li></ul></ul><ul><ul><li>Tissue Type Plasminogen Activator </li></ul></ul><ul><ul><li>Anistreplase </li></ul></ul><ul><li>OXYGEN THERAPY </li></ul><ul><li>ANALGESIC </li></ul><ul><ul><li>Morphine Sulfate </li></ul></ul>
  31. 34. <ul><li>Improve respiratory function </li></ul><ul><li>DBE </li></ul><ul><li>POSITIONING </li></ul><ul><li>Promote adequate tissue perfusion </li></ul><ul><li>OXYGEN THERAPY </li></ul>
  32. 35. <ul><li>Reduce anxiety </li></ul><ul><li>TRUSTING and CARING RELATIONSHIP </li></ul><ul><li>Patient education and home care considerations </li></ul>
  33. 36. EVALUATION
  34. 37. <ul><li>After nursing interventions, </li></ul><ul><li>goal was met. </li></ul><ul><li>The client was able to: </li></ul><ul><ul><li>verbalize relief of pain </li></ul></ul><ul><ul><li>appear comfortable </li></ul></ul><ul><ul><li>demonstrate no signs of respiratory distress </li></ul></ul>
  35. 38. <ul><ul><li>maintain adequate cardiac output as evidenced by: </li></ul></ul><ul><ul><ul><ul><li>strong peripheral pulses </li></ul></ul></ul></ul><ul><ul><ul><ul><li>normal blood pressure </li></ul></ul></ul></ul><ul><ul><ul><ul><li>clear breath sounds </li></ul></ul></ul></ul><ul><ul><ul><ul><li>adequate urine output </li></ul></ul></ul></ul><ul><ul><li>verbalize reduce fear </li></ul></ul><ul><ul><li>tolerate progressive activity </li></ul></ul><ul><ul><li>verbalize realistic expectations for progressive activity </li></ul></ul><ul><ul><li>verbalize understanding of condition and adhere to self-care program </li></ul></ul>

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