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Cardio4

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Transcript

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