A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
This slide will provide illustrative information regarding coronary angioplasty . It also focus on practical area knowledge of cardiac catheterization which one should focus while caring patient with coronary angioplasty.
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
This slide will provide illustrative information regarding coronary angioplasty . It also focus on practical area knowledge of cardiac catheterization which one should focus while caring patient with coronary angioplasty.
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
It is a rare but potentially catastrophic event that is associated with high mortality. The reported incidence of ICA varies considerably across studies.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Objectives
Explain the cardiopulmonary bypass process.
Describe five key assessment areas in the early postoperative
period.
Discuss causes of postoperative hypotension in a cardiac
surgery patient, and assessments and interventions for same.
Use the nursing process framework for managing of a post
operative thoracic surgery patient
5. Patient selected for CABG
Angina that cannot be controlled by medical therapies
Unstable angina
Positive exercise tolerance test and lesions or blockage that
cannot be treated by PTCA
Older
Have more advanced coronary diseases
Have more impaired left ventricle function
Complication from or unsuccessful PTCA
To decrease the mortality associated with bypass surgery, it is necessary to
consider
Urgency of operation
Age
Previous heart surgery
Sex
Left ventricle ejection fraction
Percentage stenosis of the left main coronary artery with greater than 60%
The number of major coronary arteries
6. Advantages and disadvantages of Using the Internal Mammary
Artery for Myocardial Revascularization
Advantages
Improved short- and long-term patency rates over saphenous
vein grafts
Diameter close to diameter of coronary arteries
Aortic anastomists not required
Internal mammary artery retains its nervous system
innervations and thus has the ability to adapt size to provide
blood flow according to myocardial demands
No leg incision if only internal mammary artery used
Vascular endothelium adapted to arterial pressure and high
flow, resulting in decreased intimal hyperplasia and
atherosclerosis
May be used as a free or sequential graft with good results
7. Disadvantages
Dissection of internal mammary artery takes longer, resulting in
longer cardiopulmonary bypass time, but this depends on
surgeon’s experience.
Extensive dissection may increase risk of postoperative bleeding.
Pleural space is entered, so pleural chest tube is required
postoperatively.
Postoperative pain may be increased because of entry into pleural
space and extensive dissection.
Use of bilateral internal mammary arteries can increase the risk of
infection and sternal dehiscence, especially in diabetic
patients.
8. Preoperative Teaching About the Intensive Care Unit Experience for the
Patient Undergoing Cardiac Surgery
Equipment to Point Out
Cardiac monitor
Arterial line
Thermodilution catheter
IV lines and IV infusion pumps
Endotracheal tube and ventilator
Suctioning
Explain how to communicate when intubated; unable to talk
Explain when extubation can be anticipated
Foley catheter (increased sensation to urinate)
Chest tubes (anticipated removal)
Pacing wires
Nasogastric tube
Soft hand restraints
9. Incisions and Dressings to Expect
Median sternotomy or other incision
Leg incision (if saphenous vein is used)
Patient’s Immediate Postoperative Appearance
Skin yellow owing to use of Betadine solution in operating room
Skin pale and cool to touch because of hypothermia during surgery
Generalized “puffiness,” especially noticeable in neck, face, and
hands, because of third spacing of fluid given during
cardiopulmonary bypass
Awakening From Anesthesia
Patient recovers in the intensive care unit (ICU); does not go to the
post anesthesia care unit
Each patient recovers from anesthesia differently Patient may feel
certain sensations
Patient may hear certain noises
Patient may be aware or able to hear but unable to respond
10. Discomfort
Amount of discomfort to be expected
When pain might be expected
Relief mechanisms
Positioning/splinting
Medications
Patient-controlled analgesia (PCA) and the importance of
early administration of pain medication
Postoperative Respiratory Care
Turning
Use of pillow to splint median sternotomy incision
Effective coughing and deep breathing after extubation; have
patient practice exercises before surgery
Incentive spirometry
Early mobilization
11. Nursing Responsibilities in Caring for the, Cardiac Surgery
Patient in the Immediate
Postoperative Period
Priority Interventions Performed by the Critical Care Team
on Arrival
Attach patient to bedside cardiac monitor and note rhythm.
Attach pressure lines to bedside monitor (arterial and
pulmonary artery); level and zero transducers and note
pressure values and waveforms.
Obtain cardiac output/index and note existing inotropic or
vasoactive drips.
12. Check peripheral pulses and perfusion signs. Connect
ventilator and auscultate breath sounds bilaterally.
Apply end-tidal carbon dioxide (ETCO2) device to ventilator
circuit and note waveform and value (best indicator of
endotracheal tube placement).
Apply pulse oximetry device to patient and note SpO2 value
and waveform.
Monitor chest tubes and character of drainage: amount,
color, flow. Check for air leaks.
Measure body temperature and initiate rewarming if
temperature <96.8 F (36 C).
13. Once the Patient Is Determined to Be Hemodynamically
Stable
Measure urine output and note characteristics.
Obtain clinical data (within 30 minutes of arrival).
Obtain chest radiograph.
Obtain 12-lead electrocardiogram (ECG).
Obtain routine blood work within 15 minutes of arrival; tests
may include ABGs, potassium, glucose, PTT, hemoglobin
(varies with institution).
Assess neurological status.
Test pacemaker function by assessing capture and sensing.
14. Examples of Nursing Diagnoses and collaborative
problems for
Cardiac Surgery Patients
1.Decreased Cardiac Output related to changes in
left ventricular preload, afterload, and contractility
2.Decreased Cardiac Output related to cardiac
dysrhythmias
3.Impaired Tissue Perfusion related to
cardiopulmonary bypass, decreased cardiac output,
hypotension
4.Impaired Tissue Perfusion related to
microembolization secondary to the surgery process
15. 5.Impaired Gas Exchange related to cardiopulmonary
bypass, anesthesia, poor chest expansion, atelectasis,
retained secretions
6.Ineffective thermoregulation realted to inection or
post pericardiotomy cyndrome
7.Impaired Comfort related to endotracheal tube,
surgical incision, chest tubes, rib spreading
8.Anxiety related to fear of death, intensive care unit
environment
9.Risk for Fluid Volume Deficit related to abnormal
bleeding
10.Risk for Infection related to surgical procedure,
invasive lines, drainage tubes, hypoventilation, retained
secretions
16. 11.Deficient knowledge about self care activities
12.Acute pain related to surgical trauma and
pleural irritation caused by chest tubes and
graft site
13.Disturbed sensory perception related to
excessive environmental stimulation and sleep
deprivation (post cardiotomy psychosis)
17. Complications:
I. Cardiac complications
Preload alteration
Hypovolemia
Persistent bleeding
Cardiac tamponade (may decrease preload of the heart by
preventing available blood from entering the heart)
Fluid overload
Afterload alteration (the force that the ventricle must
overcome to move blood forward. Vascular resistances and
alteration in body temperature are the most common causes
in Afterload alteration after cardiac surgery)
2. Hypothermia
3. Hypertension
18. 4. Heart rate alteration
Tachydysrhythmias
Bradycardia
Dysrhythmias may or may not affect cardiac output
5. Contractility alteration
Cardiac failure
Myocardiac infarction
II.Pulmonary complications
Impaired gas exchange
III.Neurological complications
Cerebrovascular accident
IV. Pain
19. V. Renal Failure and electrolyte imbalance
Renal failure
Acute tubular necrosis
Hypokalemia
Hyperkalemia
VI. Other complications
Hepatic failure
Coagulopathies
infection
20. Recovering From Cardiac Surgery
General Instructions
Avoid lifting heavy objects (10–15 lbs or more) for first 3 months.
Avoid strenuous arm movement such as golf or tennis. When getting in
and out of chair or bed, use legs. Arms should not bear weight and should
be used only for balance.
Do not drive for 6 weeks after surgery. (May ride in automobile.)
Follow physician’s instructions for activity progression.
Resume sexual activity when you can climb two flights of stairs without
stopping (with physician’s recommendations).
Use alternative positions for 3 to 4 months to decrease stress on sternum;
avoid side-lying and prone positions.
Inspect and cleanse surgical incisions daily with soap and water.
Understand medications, including reason for taking, dosage, frequency,
and side effects.
Follow dietary restrictions.
Understand how much pain to expect and how to manage it.
21. Risk Factors
Follow instructions on individual risk factors, their impact on
health after cardiac surgery, and how to modify them.
Seek referrals as appropriate (e.g., for a weight loss program
or a smoking cessation program).
Follow-up With Physician
Know how and when to schedule follow-up appointments.
Be alert for signs and symptoms of infection, such as fever,
increased redness, tenderness, drainage, or swelling of
incisions.
Report palpitations, tachycardia, or an irregular pulse (if
normally regular) to the physician immediately.
Seek follow-up care if you experience dizziness or increased
fatigue, sudden weight gain or peripheral edema, shortness of
breath, or chest pain.