Post on 14-Apr-2018
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The cardiovascular system
is responsible for transporting nutrients and
removing gaseous waste from the body. This
system is comprised of the heart and the circulatory
system. Structures of the cardiovascular system
include the heart, blood vessels, and blood.
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Heart A hollow, muscular organ located in the
center of the thorax where it occupies between
the lungs (mediastinum) and rests on thediaphragm. It weighs approximately 300g.
It composed of three layers: the endocardium (inner layer), the myocardium ( middle layer ),
and the epicardium ( exterior layer of the heart)
It has four chambers: the right and left atriumand the right and left ventricle
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Card iac Cyc le
- refers to the events of one complete heart beat.
The length of the cardiac cycle is usually about
0.8 sec. Systo le (
contraction of the muscle)-there is ventricular pumping, the chambers of the
heart become smaller as the blood is ejected.
Occurs secondary to depolarization of cells
Diastole (relaxation of the muscle)- there isventricular filling, the heart chambers fill with blood
in preparation for subsequent ejection.
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Cardiac Output Volume of blood ejected
per minute Each ventricle ejectsapproximately 70mL of blood/ beatAverages between 4-8L/min
CO = Stroke volume X heart rate =70 mlX 60 beats/min =4,200 ml/min
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MYOCARDIALINFARCTION
The formation of local necrotic areas inthe myocardium. It is usually follows
sudden coronary occlusion and the abruptcessation of blood and oxygen flow to theheart muscle
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RISK FACTORS
Age
Smoking
Hypertension
High blood cholesterol
Diabetes
Stress
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Complications:
Acute pulmonary edema
Heart failure
Cardiogenic shock
Dysrhythmias and cardiac arrest
Pericardial effusion and cardiactamponade
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Assessment and Diagnostic findings:
Patient history
12-lead ECG
Laboratory tests-serial cardiac biomarkers
-creatine kinase and its isoenzymes
-myoglobin
-troponin
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Nursing diagnosis
Ineffective cardiac tissue perfusion related toreduced coronary blood flow
Risk for imbalanced fluid volume
Risk for ineffective peripheral tissue perfusion
related to decrease cardiac output
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Medical Management:
Objective:
1.To minimize myocardial damage.
2.Preserve myocardial function and prevent
complications.
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Pharmacologic Therapy:
Analgesics
Angiotensin converting enzyme
Thrombolytics
Emergent percutaneous coronaryintervention- this procedure is used to
open the occluded coronary artery andpromite reperfussion to the area that hasbeen deprived of oxygen.
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Nursing management:
Administer oxygen
Monitor vital signs
Physical rest in bed with the backrestelevated or in a supportive chair.
Rationale: Help decrease chest discomfortand dyspnea.
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Improving respiratory function
Monitor fluid volume status
Rationale: To prevent overloading the heartand lungs.
Encourage the patient to breathe deeplyand change position frequently.
Rationale: To help keep fluid from pooling
in the bases of the lungs.
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Promoting adequate tissue perfusion
Bed or chair rest during initial phase of treatment.
Rationale: Helps reduce myocardial oxygen
consumption
Check skin temp. and peripheral pulsesfrequently to monitor tissue perfusion.
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Reducing anxiety
Ensure a quiet environment
Preventing interruptions that disturb
sleep.
Teaching relaxation techniques
Providing emotional and spiritual support.
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Invasive Coronary
Artery Procedures
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PTCA (PercutaneousTransluminal Coronary
Angioplasty)
Purpose: To improve blood flow within a
coronary artery by compressing and “cracking” the atheroma.
A balloon-tipped catheter is used to open
blocked coronary vessels and resolveischemia.
Used in patient with angina and an
intervention for ACS.
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CORONARY ARTERY
STENT This may be placed to overcome the
release of mediators that leads to
vasoconstriction, clotting and scar tissueformation.
Stent is a metal mesh that providesstructural support to a vessel at risk of
acute closure. The stent is positioned over the
angioplasty balloon.
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ATHERECTOMY
An invasive interventional procedure thatinvolves the removal of the atheroma, or
plaque from a coronary artery by cutting,shaving or grinding.
It may be used in conjunction with PTCA.
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CARDIOPULMONARYBYPASS
This procedure mechanically circulatesand oxygenates blood for the body whilebypassing the heart and lungs.
Accomplished by placing a cannula in theright atrium, vena cava or femoral vein towithdraw blood from the body.
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1. The incidence of coronary artery disease
tends to be equal for men and women after the age of:
a. 45 years
b. 50 yearsc. 55 years
d. 65 years
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2.The classic ECG changes that occur with
an MI include all except :
a. an absent P wave
b. an abnormal Q wavec. T wave inversion
d. ST segment elevation
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3.The most common site of myocardial
infarction is the:
a. left atrium
b. left ventriclec. right atrium
d. right ventricle
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4.Which of the following statements about
myocardial infarction pain is incorrect
a. It is relieved by rest and inactivity
b. It is substernal in location
c. It is sudden in onset and prolonged induration
d. It is viselike and radiates to the shoulders
and arms
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5.Myocardial cell damage can be reflected by
high levels of cardiac enzymes. The cardiac
isoenzyme is:
a. alkaline phosphatase
b. creatine kinase ( CK-MB)c. myoglobin
d. troponin
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6-8 NURSING DIAGNOSIS for MYOCARDIAL
INFARCTION
9-10 nursing management for patient with MI