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CARE OF CLIENTS WITH   PROBLEMS IN   OXYGENATION       (PART 2)     Mr. Jayesh Patidar
DIAGNOSTIC TESTS
CK-MB (CREATININEKINASE, MYOCARDIAL MUSCLE) Anelevation in value indicates myocardial damage An elevation occurs within ...
LACTATE DEHYDROGENASE (LDH) Elevationsin LDH levels occur 24 hours following myocardial infarction and peak in 48 to 72 h...
TROPONIN Is composed of troponin C, cardiac troponin I, and cardiac troponin T Has a high affinity for myocardial injury...
COMPLETE BLOOD COUNT RBC  decreases in rheumatic heart disease and infective endocarditis and increases in conditions cha...
 Elevated hematocrit level can result from vascular volume depletion Decreases   in hematocrit and hemoglobin levels can...
SERUM LIPIDS The   lipid     profile   measures   serum cholesterol,   triglyceride, and lipoprotein levels Isused to as...
B-TYPE NATRIURETIC PEPTIDE (BNP) Isreleased in response to atrial and ventricular stretch; it serves as a marker for cong...
ELECTROCARDIOGRAPHY Noninvasive test that records the electrical activity of the heart and is useful for detecting cardia...
INTERVENTIONS Determine  the client’s ability to lie still; advise the client to lie still, breathe normally, and refrain...
ECHOCARDIOGRAPHY Noninvasive  procedure based on the principles of ultrasound and evaluates structural and functional cha...
EXERCISE TESTING (STRESS TEST) Noninvasive   test that studies the heart during activity and detects and evaluates corona...
INTERVENTIONS Obtain   an informed consent if required Provideadequate rest the night before the procedure Instruct    ...
 Instructclient to wear nonconstrictive, comfortable clothing and supportive rubber- soled shoes for the exercise stress ...
DIGITAL SUBTRACTION ANGIOGRAPHY This  test combines x-ray techniques and a  computerized subtraction technique with  fluo...
INTERVENTIONS Assess  for allergies to seafood, iodine, or radiopaque dyes. Premedicate client with antihistamines or cor...
MAGNETIC RESONANCE IMAGING Noninvasive  diagnostic test that produces an image of the heart or great vessels through inte...
INTERVENTIONS Evaluate  client for the presence of pacemaker or other implanted items that present a contraindication to ...
SICKLE CELL ANEMIA
 Constitutes  a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by ab...
 Insufficientoxygen causes the cells to assume a sickle cell shape and the cells become          rigid       and         ...
 At   risk are those having parents heterozygous for hemoglobin S or being of African American descent Sicklecell crises...
VASO-OCCLUSIVE CRISIS Caused  by stasis of blood with lumping of the           cells          in            the microcirc...
SPLENIC SEQUESTRATION Caused   by the pooling and clumping of blood in the spleen (hypersplenism). Profound   anemia, hy...
APLASTIC CRISIS Caused    by the diminished production and increased destruction of RBC, triggered by viral infection or ...
INTERVENTIONS Maintainadequate hydration and blood flow with IV administered NSS and with oral fluids Administer   oxyge...
 Assist the child to assume a comfortable position so that the child keeps the extremities extended to promote venous ret...
 Administer  antibiotics as prescribed to prevent infection Monitorfor signs of complications, including increasing anem...
IRON DEFICIENCY ANEMIA
 Ironstores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in RBC Commonly  res...
SIGNS AND SYMPTOMS Pallor Weakness       and fatigue Irritability
INTERVENTIONS Increase   the oral intake of iron Instructthe child and parents in food choices that are high in iron Ad...
 Give iron supplements with a multivitamin or fruit juice because vitamin C increases absorption Do not give iron supple...
HEMOPHILIA
 Refers  to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins Factor      VIII ...
 Most frequently transmitted by the union of an unaffected male with a trait-carrier female; however, it can result from ...
SIGNS AND SYMPTOMS Abnormal  bleeding in response to trauma or surgery (usually detected after circumcision) Epistaxis ...
INTERVENTIONS Monitorfor bleeding and maintain bleeding precautions Prepare to administer replacement factors as prescri...
 Control       joint        bleeding    by immobilization,      elevation,    and the application of ice; in addition, ap...
 Instruct         the child to wear protective devices such as helmets and knees and elbow pads when participating in spo...
KAWASAKI DISEASE
 Is  known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory illness The cause is unknown but m...
SIGNS AND SYMPTOMS Fever Conjunctival   hyperemia Red   throat               acute stage Swollen  hands, rash,and enla...
 Crackling lipsand fissures Desquamation    of theskin on the tips of thefingers and toes                             su...
 Convalescent   stage   appears normal but signs of inflammation    may be present
 Irritability            may last up for up to 2 months after  the onset of symptoms Peeling   of the hands and feet may...
INTERVENTIONS Monitor temperatures frequently (refer if 101F or higher) Assess    heart sounds, rate, and rhythm Assess...
 Monitor   strict intake and output Administer  soft foods and liquids that are neither too hot nor too cold Weigh   th...
 Administerimmune globulin intravenously as prescribed to reduce the duration of the fever and the incidence of coronary ...
CORONARY ARTERY DISEASE
 Narrowing   or obstruction of one or more coronary      arteries   as     a     result of atherosclerosis, which is an a...
 Coronary artery narrowing is significant if the lumen diameter of the left main artery is reduced at least 50%, or if an...
SIGNS AND SYMPTOMS Chest   pain Palpitations Dyspnea Syncope Cough    or hemoptysis Excess   fatigue
 When  blood flow is reduced and ischemia occurs, ST segment depression, T wave inversion, or both is noted; ST segment r...
INTERVENTIONS Instruct         the client regarding the purpose of diagnostic medical and surgical procedures and pre pro...
 Instruct   the client regarding a low- calorie, low sodium, low cholesterol, and low fat diet with an increase in dietar...
SURGICAL PROCEDURES PTCA  to compress the plaque against the walls of the artery and dilate the vessel Laser   angioplas...
ANGINA
 Chest  pain resulting from myocardial ischemia caused by inadequate myocardial blood and oxygen supply Caused by an imb...
PATTERNS OF ANGINA Stable   Angina     Also called exertional angina     Occurs with activities that involve exertion o...
 Unstable    Angina     Also called preinfarction angina     Occurs with an unpredictable degree of      exertion or em...
 Variant   Angina     Also called Prinzmetal’s or vasospastic angina     Results from coronary artery spasm     May oc...
 Intractable     Angina      –     is     a chronic, incapacitating angina unresponsive to interventions Preinfarction  ...
SIGNS AND SYMPTOMS Pain Dyspnea Pallor Sweating Palpitations   and tachycardia
 Dizziness   and faintness Hypertension Digestive   disturbances
INTERVENTIONS Assess    pain Provide   bed rest Administer oxygen at 3L/min by nasal cannula as prescribed Administer ...
 Provide    a continuous cardiac monitoring Assist  the client in identifying angina- precipitating events Instruct    ...
 Assist      client to identify risk factors that can be modified Provide   dietary instructions Provide community reso...
MYOCARDIAL INFARCTION
 Occurswhen myocardial tissue is abruptly and severely deprived of oxygen Ischemia   can lead to necrosis of myocardial ...
 Not all clients experience    the   classic symptoms of an MI Women   may experience atypical discomfort , shortness of...
SIGNS AND SYMPTOMS Pain Nausea   and vomiting Diaphoresis Dyspnea Dysrhythmias
 Feelings   of fear and anxiety Pallor Cyanosis Coolness   of extremities
INTERVENTIONS Obtain   a description of the chest discomfort Assess   vital signs Assess   cardiovascular status Place...
 Establish   an IV access route Administer   nitroglycerin as prescribed Administer  morphine sulphate as prescribed to...
 Administer   beta blockers as prescribed Assess  distal     peripheral   pulses     and   skin temperature Monitor   i...
 Maintainbed rest for the first 24 to 36 hours as prescribed Allowthe client to stand to void or use a bed side commode ...
RAYNAUD’S DISEASE
 Vasospasms  of the arterioles and arteries of the upper and lower extremities Vasospasms  cause       constriction   of...
SIGNS AND SYMPTOMS Blanching of the extremity, followed by cyanosis during constriction Reddened    tissue when the vaso...
INTERVENTIONS Monitor    pulses Administer    vasodilators as prescribed Assist  the client to identify and avoid preci...
 Instruct        the client to wear warm clothing, socks and gloves in cold weather Advise   client to avoid injuries to...
BUERGER’S DISEASE
 Thromboangiitis   obliterans An occlusive disease of the median and small arteries and veins Thedistal upper and lower...
SIGNS AND SYMPTOMS Intermittent   claudication Ischemic   pain occurring in the digits while at rest Aching   pain that...
 Extremities            that are cool and red in the dependent position Development   of   ulcerations   in   the extrem...
INTERVENTIONS Instruct   the client to stop smoking Monitor    pulses Instruct        the client to avoid injury to the...
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38824331 care-of-clients-with-problems-in-oxygenation-part-2

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38824331 care-of-clients-with-problems-in-oxygenation-part-2

  1. 1. CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION (PART 2) Mr. Jayesh Patidar
  2. 2. DIAGNOSTIC TESTS
  3. 3. CK-MB (CREATININEKINASE, MYOCARDIAL MUSCLE) Anelevation in value indicates myocardial damage An elevation occurs within 4 to 6 hours and peaks 18 to 24 hours following an acute ischemic attack Normal value is 0% to 5% of total; total CK is 26 to 174 units/L
  4. 4. LACTATE DEHYDROGENASE (LDH) Elevationsin LDH levels occur 24 hours following myocardial infarction and peak in 48 to 72 hours Normally, LDH1 is lower than LDH2; when the serum concentration of LDH1 is higher than LDH2, the pattern is indicated as “flipped”, signifying myocardial necrosis 140 to 280 IU/L
  5. 5. TROPONIN Is composed of troponin C, cardiac troponin I, and cardiac troponin T Has a high affinity for myocardial injury; it rises within 3 hours and persists for up to 7 days Troponin I – lower than 0.6ng/mL Troponin T – 0 to 0.2ng/mL
  6. 6. COMPLETE BLOOD COUNT RBC decreases in rheumatic heart disease and infective endocarditis and increases in conditions characterized by inadequate tissue oxygenation The WBC increases in infectious and inflammatory diseases of the heart and after MI to dispose necrotic tissue resulting from infarction
  7. 7.  Elevated hematocrit level can result from vascular volume depletion Decreases in hematocrit and hemoglobin levels can indicate pneumonia
  8. 8. SERUM LIPIDS The lipid profile measures serum cholesterol, triglyceride, and lipoprotein levels Isused to assess the risk of developing coronary artery disease Serum cholesterol – lower than 200mg/dL LDL – lower than 130mg/dL HDL – 30 to 70 mg/dL
  9. 9. B-TYPE NATRIURETIC PEPTIDE (BNP) Isreleased in response to atrial and ventricular stretch; it serves as a marker for congestive heart failure Should be lower than 100pg/mL Thehigher the level, the more severe the congestive heart failure
  10. 10. ELECTROCARDIOGRAPHY Noninvasive test that records the electrical activity of the heart and is useful for detecting cardiac dysrhythmias, location and extent of MI, and cardiac hypertrophy and for evaluation of the effectiveness of medications
  11. 11. INTERVENTIONS Determine the client’s ability to lie still; advise the client to lie still, breathe normally, and refrain from talking during the test Reassure the client that an electrical shock will not occur Document any cardiac medications the client is taking
  12. 12. ECHOCARDIOGRAPHY Noninvasive procedure based on the principles of ultrasound and evaluates structural and functional changes in the heart Heart chamber size is measured, ejection fraction is calculated, and flow gradient across the valve is determined
  13. 13. EXERCISE TESTING (STRESS TEST) Noninvasive test that studies the heart during activity and detects and evaluates coronary artery disease Treadmill testing is the most commonly used mode of stress testing
  14. 14. INTERVENTIONS Obtain an informed consent if required Provideadequate rest the night before the procedure Instruct the client to eat a light meal 1 to 2 hours before the procedure Instruct the client to avoid smoking, alcohol and caffeine before the procedure
  15. 15.  Instructclient to wear nonconstrictive, comfortable clothing and supportive rubber- soled shoes for the exercise stress test Instruct the client to notify the physician if any chest pain, dizziness, or shortness of breath occurs during the procedure Instruct client to avoid taking a hot bath or shower for at least 1 to 2 hours after the procedure
  16. 16. DIGITAL SUBTRACTION ANGIOGRAPHY This test combines x-ray techniques and a computerized subtraction technique with fluoroscopy for visualization of the cardiovascular systemA contrast media (dye) is injected
  17. 17. INTERVENTIONS Assess for allergies to seafood, iodine, or radiopaque dyes. Premedicate client with antihistamines or corticosteroids to prevent a reaction Obtain informed consent Monitor vital signs Assess injection site for bleeding or discomfort
  18. 18. MAGNETIC RESONANCE IMAGING Noninvasive diagnostic test that produces an image of the heart or great vessels through interaction of magnetic fields, radio waves, and atomic nuclei Provides information on chamber size and thickness, valve and ventricular function, and blood flow through the great vessels and coronary arteries
  19. 19. INTERVENTIONS Evaluate client for the presence of pacemaker or other implanted items that present a contraindication to the test Ensure client has removed all metallic objects such as watch, jewelry, clothing with metal fasteners, and metal hair fasteners Informclient that she or he may experience claustrophobia while in scanner
  20. 20. SICKLE CELL ANEMIA
  21. 21.  Constitutes a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S Caused by inheritance of a gene for a structurally abnormal portion of the hemoglobin chain Hemoglobin S is sensitive to changes in the oxygen content of the RBC
  22. 22.  Insufficientoxygen causes the cells to assume a sickle cell shape and the cells become rigid and clumped together, obstructing capillary blood flow Situations that precipitate sickling include fever and emotional or physical stress; any condition that increases the need for oxygen or alters the transport of oxygen can result in sickle cell crisis
  23. 23.  At risk are those having parents heterozygous for hemoglobin S or being of African American descent Sicklecell crises are acute exacerbations of the disease, which vary considerably in severity and frequency ; these include vaso- occlusive crisis, splenic sequestration, and aplastic crisis
  24. 24. VASO-OCCLUSIVE CRISIS Caused by stasis of blood with lumping of the cells in the microcirculation, ischemia, and infarction Fever, painful swelling of the hands, feet, and joints, and abdominal pain
  25. 25. SPLENIC SEQUESTRATION Caused by the pooling and clumping of blood in the spleen (hypersplenism). Profound anemia, hypovolemia, and shock
  26. 26. APLASTIC CRISIS Caused by the diminished production and increased destruction of RBC, triggered by viral infection or the depletion of folic acid Profound anemia and pallor
  27. 27. INTERVENTIONS Maintainadequate hydration and blood flow with IV administered NSS and with oral fluids Administer oxygen and blood products as prescribed Administer analgesics as prescribed(ATC) Administration of meperidine (Demerol) is avoided
  28. 28.  Assist the child to assume a comfortable position so that the child keeps the extremities extended to promote venous return Elevate the bed of the head 30 degrees, avoid putting strain on painful joints, and do not raise the knee gatch of the bed Encourage consumption of high-calorie, high protein diet, with folic acid supplementation
  29. 29.  Administer antibiotics as prescribed to prevent infection Monitorfor signs of complications, including increasing anemia, decreased perfusion, and shock Instructthe child and parents about the early signs and symptoms of crisis and the measures to prevent crisis
  30. 30. IRON DEFICIENCY ANEMIA
  31. 31.  Ironstores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in RBC Commonly results from blood loss, increased metabolic demands, syndromes of GI malabsorption and dietary inadequacy
  32. 32. SIGNS AND SYMPTOMS Pallor Weakness and fatigue Irritability
  33. 33. INTERVENTIONS Increase the oral intake of iron Instructthe child and parents in food choices that are high in iron Administer iron supplements as prescribed Giveiron supplements between meals for maximum absorption
  34. 34.  Give iron supplements with a multivitamin or fruit juice because vitamin C increases absorption Do not give iron supplements with milk or antacids because these items decrease absorption Teach the child and parents that a liquid iron preparation stains the teeth and should be taken through a straw Inform parents/client on side effects (constipation, black stools, foul aftertaste)
  35. 35. HEMOPHILIA
  36. 36.  Refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins Factor VIII deficiency (hemophilia A or classic hemophilia) Factor IX deficiency (hemophilia B or Christmas disease) Result as an X-linked recessive disorder
  37. 37.  Most frequently transmitted by the union of an unaffected male with a trait-carrier female; however, it can result from the union between an affected male and a normal or carrier female
  38. 38. SIGNS AND SYMPTOMS Abnormal bleeding in response to trauma or surgery (usually detected after circumcision) Epistaxis Joint bleeding causing pain, tenderness, swelling and limited ROM Tendency to bruise easily Platelet test is normal; clotting factor function may be abnormal
  39. 39. INTERVENTIONS Monitorfor bleeding and maintain bleeding precautions Prepare to administer replacement factors as prescribed Monitor for joint pain; immobilize the affected extremity if joint pain occurs Assess neurological status (child is at risk for intracranial hemorrhage)
  40. 40.  Control joint bleeding by immobilization, elevation, and the application of ice; in addition, apply pressure (15 minutes) for superficial bleeding Instruct parents how to control bleeding Instruct the parents on activities to be avoided by the child, emphasizing avoidance of contact sports and the need for protective devices while learning to walk
  41. 41.  Instruct the child to wear protective devices such as helmets and knees and elbow pads when participating in sports such as bicycling and skating
  42. 42. KAWASAKI DISEASE
  43. 43.  Is known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory illness The cause is unknown but may be associated with an infection from an organism or toxin Cardiac involvement is the most serious complication; aneurysms can develop
  44. 44. SIGNS AND SYMPTOMS Fever Conjunctival hyperemia Red throat acute stage Swollen hands, rash,and enlargement of thecervical lymph nodes
  45. 45.  Crackling lipsand fissures Desquamation of theskin on the tips of thefingers and toes subacute stage Joint pain Cardiac manifestations Thrombocytosis
  46. 46.  Convalescent stage appears normal but signs of inflammation may be present
  47. 47.  Irritability may last up for up to 2 months after the onset of symptoms Peeling of the hands and feet may occur Pain in the joints may persist for several weeks Stiffnessin the morning, after naps, and in cold temperatures may occur
  48. 48. INTERVENTIONS Monitor temperatures frequently (refer if 101F or higher) Assess heart sounds, rate, and rhythm Assessextremities for edema, redness, and desquamation Examine eyes for conjunctivitis Monitor mucous membranes for inflammation
  49. 49.  Monitor strict intake and output Administer soft foods and liquids that are neither too hot nor too cold Weigh the child daily Provide passive range of motion exercises to facilitate joint movement Administer ASA as prescribed
  50. 50.  Administerimmune globulin intravenously as prescribed to reduce the duration of the fever and the incidence of coronary artery lesions and aneurysms
  51. 51. CORONARY ARTERY DISEASE
  52. 52.  Narrowing or obstruction of one or more coronary arteries as a result of atherosclerosis, which is an accumulation of lipid-containing plaque in the arteries Causes decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply Symptoms occur when the coronary artery is occluded to the point that inadequate blood supply to the muscle occurs causing ischemia
  53. 53.  Coronary artery narrowing is significant if the lumen diameter of the left main artery is reduced at least 50%, or if any major branch is reduced at least 75% The goal of treatment is to alter atherosclerotic progression Cardiac catheterization provides the most definitive source for diagnosis
  54. 54. SIGNS AND SYMPTOMS Chest pain Palpitations Dyspnea Syncope Cough or hemoptysis Excess fatigue
  55. 55.  When blood flow is reduced and ischemia occurs, ST segment depression, T wave inversion, or both is noted; ST segment returns to normal when the blood flow returns With infarction, cell injury results in ST segment elevation, followed by T wave inversion and an abnormal Q wave Blood lipid levels may be elevated
  56. 56. INTERVENTIONS Instruct the client regarding the purpose of diagnostic medical and surgical procedures and pre procedure and post procedure expectations Assist the client to identify risk factors that can be modified Assist the client to set goals to promote lifestyle changes to reduce the impact of risk factors
  57. 57.  Instruct the client regarding a low- calorie, low sodium, low cholesterol, and low fat diet with an increase in dietary fiber Stressto the client that dietary changes are maintained for life Provide community resources to the client regarding exercise, smoking cessation, and stress reduction as prescribed
  58. 58. SURGICAL PROCEDURES PTCA to compress the plaque against the walls of the artery and dilate the vessel Laser angioplasty to vaporize the plaque Atherectomy to remove the plaque from artery Coronary artery bypass grafting to improve blood flow to the myocardial tissue at risk for ischemia or infarction
  59. 59. ANGINA
  60. 60.  Chest pain resulting from myocardial ischemia caused by inadequate myocardial blood and oxygen supply Caused by an imbalance between oxygen supply and demand Causes include obstruction of coronary blood flow resulting from atherosclerosis, coronary artery spasm, or conditions increasing myocardial oxygen consumption
  61. 61. PATTERNS OF ANGINA Stable Angina  Also called exertional angina  Occurs with activities that involve exertion or emotional stress; relieved with rest or nitroglycerin  Usually has a stable pattern of onset, duration, severity and relieving factors
  62. 62.  Unstable Angina  Also called preinfarction angina  Occurs with an unpredictable degree of exertion or emotion and increases in occurrence, duration, and severity over time  Pain may not be relieved with nitroglycerin
  63. 63.  Variant Angina  Also called Prinzmetal’s or vasospastic angina  Results from coronary artery spasm  May occur at rest  Attacks may be associated with ST segment elevation noted on the ECG
  64. 64.  Intractable Angina – is a chronic, incapacitating angina unresponsive to interventions Preinfarction Angina  Associated with acute coronary insufficiency  Lasts longer than 15 minutes  Symptom of worsening cardiac ischemia  Occurs after an MI, when residual ischemia may cause episodes of angina
  65. 65. SIGNS AND SYMPTOMS Pain Dyspnea Pallor Sweating Palpitations and tachycardia
  66. 66.  Dizziness and faintness Hypertension Digestive disturbances
  67. 67. INTERVENTIONS Assess pain Provide bed rest Administer oxygen at 3L/min by nasal cannula as prescribed Administer nitroglycerin as prescribed Obtain a 12-lead ECG
  68. 68.  Provide a continuous cardiac monitoring Assist the client in identifying angina- precipitating events Instruct client to stop activity and rest if chest pain occurs and to take nitroglycerin as prescribed Instruct client to seek medical attention if pain persists
  69. 69.  Assist client to identify risk factors that can be modified Provide dietary instructions Provide community resources to the client regarding exercise, smoking cessation, and stress reduction
  70. 70. MYOCARDIAL INFARCTION
  71. 71.  Occurswhen myocardial tissue is abruptly and severely deprived of oxygen Ischemia can lead to necrosis of myocardial tissue if blood flow is not restored Infarctiondoes not occur instantly but evolves over several hours Obvious physical changes do not occur in the heart until 6 hours after the infarction, when the infarcted areas appears blue and swollen
  72. 72.  Not all clients experience the classic symptoms of an MI Women may experience atypical discomfort , shortness of breath, or fatigue Anolder client may experience shortness of breath, pulmonary edema, dizziness, altered mental status, or a dysrhythmia
  73. 73. SIGNS AND SYMPTOMS Pain Nausea and vomiting Diaphoresis Dyspnea Dysrhythmias
  74. 74.  Feelings of fear and anxiety Pallor Cyanosis Coolness of extremities
  75. 75. INTERVENTIONS Obtain a description of the chest discomfort Assess vital signs Assess cardiovascular status Place client in a semi-Fowler’s position Administeroxygen at 2 to 4L/min by nasal cannula as prescribed
  76. 76.  Establish an IV access route Administer nitroglycerin as prescribed Administer morphine sulphate as prescribed to relieve chest discomfort Obtain a 12-lead ECG Monitor thrombolytic therapy, which may be prescribed for the first 6 hours of the coronary event
  77. 77.  Administer beta blockers as prescribed Assess distal peripheral pulses and skin temperature Monitor intake and output Assess RR and breath sounds for signs of heart failure Monitor BP closely Provide reassurance to the client and family
  78. 78.  Maintainbed rest for the first 24 to 36 hours as prescribed Allowthe client to stand to void or use a bed side commode if prescribed Provide ROM exercises Encourage client to verbalize feeling regarding the MI
  79. 79. RAYNAUD’S DISEASE
  80. 80.  Vasospasms of the arterioles and arteries of the upper and lower extremities Vasospasms cause constriction of the cutaneous vessels Attacksare intermittent and occur with exposure to cold or stress Affects primarily fingers, toes, ears, and cheeks
  81. 81. SIGNS AND SYMPTOMS Blanching of the extremity, followed by cyanosis during constriction Reddened tissue when the vasospasm is relieved Numbness, tingling, swelling, and a cold temperature at the affected body part
  82. 82. INTERVENTIONS Monitor pulses Administer vasodilators as prescribed Assist the client to identify and avoid precipitating factors such as cold and stress Instruct the client to avoid smoking
  83. 83.  Instruct the client to wear warm clothing, socks and gloves in cold weather Advise client to avoid injuries to fingers and hands
  84. 84. BUERGER’S DISEASE
  85. 85.  Thromboangiitis obliterans An occlusive disease of the median and small arteries and veins Thedistal upper and lower limbs are affected most commonly
  86. 86. SIGNS AND SYMPTOMS Intermittent claudication Ischemic pain occurring in the digits while at rest Aching pain that is more severe at night Cool, numb, or tingling sensation Diminished distal pulses
  87. 87.  Extremities that are cool and red in the dependent position Development of ulcerations in the extremities
  88. 88. INTERVENTIONS Instruct the client to stop smoking Monitor pulses Instruct the client to avoid injury to the upper and lower extremities Administer vasodilators as prescribed

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