2myocardial Infarction
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MYOCARDIAL
INFARCTION
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LEARNING OBJECTIVES
� At the end of the day the discussion, the
students will be able to:
a. Identify myocardial infarction
b. Understand the etiology of MIc. Describe the sign and symptoms of MI
d. Comprehend various nursing
interventions and its stages.
e. Explain nursing managementf. List the medications use for MI
g. Discuss nursing process
h. Know the complications of MI
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DEFINITION� Process by which myocardium tissue is
destroyed due to reduced coronary blood
flow and lack of oxygen; actual necrosis of
heart muscle occurs.
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ETIOLOGY
1. Insufficient myocardial blood supply is
associated with
a. Atherosclerosis
b. Arteriosclerosisc. Vasospasm
d. Myocardial hypertrophy
e. Severe anemias
f. Respiratory disease (oxygen deficit)
g. Hyperthyroidism (increase force of
contractions)
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MANIFESTATIONS
A. CHEST PAIN
1. Heavy (viselike, crushing,
squeezing) chest pain that
may radiate down left arm,hand, jaw and neck.
2. Not relieved by rest often
lasts longer than 15
minutes.
3. Women have a slightly
different presentation:
back pain, indigestion with
nausea, cold sweating,
weakness, pallor.
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B. Nausea, vomiting due to stress
reaction
C. Diaphoresis, dizziness due tosympathetic reaction
D. Drop in blood pressure
E. ECG changes: inverted T wave
and depressed ST segmentindicate ischemic changes,
elevated S segment and
widened QRS indicate infarction
F. Denial/anxietyG. Increased Troponin I and T,
MB-CPK, LDH isoenzymes:
done in serials of three to see
trends.
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NORMAL ECG
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NURSING
INTERVENTIONS
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a. EARLY STAGE
1. Treat dysrhythmia properly:
antiarrhythmics such as lidocaine
(xylocaine)
2. Give analgesics: morphine
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3. Maintain bed rest: Semi-Fowler¶s position
to decrease venous return and rest
myocardium.
4. Administer oxygen via cannula
5. Monitor vital signs
6. Administer aspirin and heparin to
decrease thrombosis.
7. Administer propr anolol HCL (Inderal):
decreases heart rate and decreases work
of myocardium.
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8. Administer calcium channel blockers:
decrease after load: vasodilators:
increases oxygen to myocardium;
decreases preload and after load
9. Provide emotional support
10.Administer streptokinase (kabikinase) or
TPA (³clot busters´): if client arrives
within first 6 hours; major side effect is
bleeding.
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LATE
1. Administer stool softeners to decrease
myocardial workload.
2. Provide low-fat, low cholesterol, low-
sodium diet, soft food.3. Utilize bedside commode: cause less
energy expenditure than using a bedpan.
4. Promote self -care to tolerance; stop at the
onset of pain.
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5. Plan for cardiac rehabilitation
a. Exercise program: stop if fatigue or chestpain occurs
b. Stress management
c. Teach modifiable risk factors reduction
1. Obesity2. Stress
3. Diet
4. Hypertension
5. Smoking6. Lack of exercise
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d. Recognize non modifiable risk factors
� Heredity
� Race
� Age
� Sex
� Type ³A´ personality
e. Psychological support
f. Long-term drug therapy
1. Antiarrhythmics: quinidine
2. Anticoagulants: heparin, aspirin,
warf arin (Coumadin), enoxaparin
(Lovenox)
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3. Antihypertensives: propr anolol (I nderal),
chlorothiazide (Diuril), and calcium
channel blocker s
4. Vasodilators ± nitroglycerin (nitro-bid)calcium channel blockers.
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ASPIRIN
� known as acetylsalicylic acid
� analgesic to relieve minor aches and
pains,
� antipyretic to reduce fever,� anti-
� to help prevent heart attacks, strokes, and
blood clot formation in people at high risk
for developing blood clots. inflammatorymedication.
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NURSING MANAGEMENT
� Pain management
Morphine 5-10 mg
� Other medication- nitroglycerin, antiplatelet
& thrombolytic� Keep patient CRIB
� Monitor urine output.
� Relieve nausea and vomiting ² Stemetil
12.5 mg I/V� Soft diet
� Avoid constipation ± give laxative
� Encourage light activities
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HEPARIN
� an anticoagulant (blood thinner) that
prevents the formation of blood clots. It
works by blocking reactions in the bodythat lead to blood clots.
� Do not use this medication if you are
allergic to heparin, or if you have:
a. a severe lack of platelets in your blood; or
b. uncontrolled bleeding.
�
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Calcium channel blockers
� prevent calcium from entering cells of the heart
and blood vessel walls, resulting in lower blood
pressure. Calcium channel blockers, also called
calcium antagonists, relax and widen blood
vessels by affecting the muscle cells in the
arterial walls.� Examples of calcium channel blockers include:
1. Amlodipine (Norvasc)
2. Diltiazem (Cardizem LA, Dilacor XR, Tiazac)
3. Felodipine (Plendil)
4. Isradipine (DynaCirc CR)5. Nicardipine (Cardene, Cardene SR)
6. Nifedipine (Procardia, Procardia XL, Adalat CC)
7. Nisoldipine (Sular)
8. Verapamil (Calan Verelan, Covera-HS)
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THROMBOSIS
� is the formation of a blood
clot inside a blood vessel,
obstructing the flow of
blood through the
circulatory system.
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NURSING DIAGNOSIS
� Pain: chest pain/discomfort related to decreasedcoronary blood supply
� Risk for decreased cardiac output
� Activity intolerance R/T fatigue/ shortness of breath
� Fear/Anxiety R/T hospitalization
� Knowledge deficit regarding disease condition &treatment
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Nur sing process
1 Chest pain related to reduced coronary
blood flow.
� Observe or monitor signs and symptoms
associated with pain, such as BP, heart rate,temperature, color and moisture of skin,
restlessness, and ability to focus.
� Assess and record chest pain ± location,
type, severity, aggravation/alleviation
factors, duration, onset.
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CONT«
� Obtain 12 lead ECG on admission & each timechest pain recurs
� Give pain relief medication
� Administer nitrates� Inform physician about the pain & record
patient·s response to medication. Give
oxygen ther apy as ordered.
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� CRIB RIB gradually increasethe level of physical activities as tolerated.
� Plan activities according to patient¶s
tolerance. Allow rest during and between
activities.� Discuss with patient about alternative
therapy to relief pain such as music therapy,
meditation.
� Educate patient on chest pain: To report anychest pain to the nurse.
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2 Risk for decreased cardiac output� Assess pt level of consciousness/mental
alertness
� Monitor vital sign-look for sign of hypotension
� Monitor urine output
� Monitor for pallor, sweating, cyanosis-sign of
peripheral hypo perfusion
� Assess the effect of medication
� Monitor ABG
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� Assess and record patient·s level of tolerance toactivities of daily living.
� Encourage patient to verbalize activities thatincrease fatigue or shortness of breath.
� Provide rest period between and during activities� Keep frequently used items within reach of
patient.� Give encouragement and promotes independence
in activities within patient·s limit.� Assist patient in activities of daily living.
3 Activity intolerance related tofatigue / shortness of breath
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� Stress management
� Avoid strenuous activity, but canencourage mild exercises
� Advise patient on sign and symptom of
recurrent MI� Advise on medication and its side effect
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Health education� Reduce weight
� Low salt, cholesterol diet, avoid heavymeal
� Stop smoking
� Avoid alcohol
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ANGINA
PECTORIS
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OBJECTIVES
At the end of this the students will be able to
a. Define angina pectoris
b. Understand the causes of angina pectoris
c. Explain the precipitating caused. Knowledgeable on the patterns of angina
e. Know the sign and symptoms of angina
pectoris
f. Understand the different diagnosticprocedure for angina pectoris
g. Explain the rational on nursing
interventions
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� Is a chest pain resulting from
myocardial ischemia caused by
inadequate myocardial blood and
oxygen supply.
� Caused by an imbalance
between oxygen supply anddemand.
� Causes include:
a. Obstruction of coronary blood
flow because of atherosclerosisb. Coronary artery spasm
c. Conditions increasing myocardial
oxygen consumption
ANGINA PECTORIS
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1. ATHEROSCLEROSIS
� Atherosclerosis (ath-er -o-skler -O-
sis) is a disease in which plaque
(plak) builds up inside your
arteries.
� Fatty deposits, called "Atheromas"
or plaques, damage the lining of
arteries causing them to narrowand harden.
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� Plaque is made up of fat, cholesterol, calcium,
and other substances found in the blood.
� Plaque hardens and narrows your arteries,
limiting the flow of oxygen-rich blood to your
organs and other parts of your body. This can
lead to serious problems, including heart attack,stroke, or even death
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2. CORONARY SPASM
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Chest pain
Increased oxygen demand
Increased Blood pressure
Vasoconstriction
Exposure to cold
ETIOLOGY
Increasedphysicalexertion
Oxygendemand
Chest pain
1. 2.
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� To provide relief of an acute attack.
� Correct the imbalance between myocardial
oxygen supply and demand
� Prevent progression of the disease and
further attacks to reduce the risk of MI.
Goal of treatment:
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PRECIPITATION FACTORS
CAUSE ANGINA
1. Running upstairs,
2. Getting angry
3. Respiratory infection with fever
4. Exposure to cold weather or eating alarge meal.
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1. STABLE ANGINA
a. Also called exertional angina.b. Occurs with activities that involve exertion
or emotional stress and is relieved with
rest or nitroglycerin.
c. Usually has a stable pattern of onset,
duration, severity and relieving factors.
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2. UNSTABLE ANGINA
a. Also called preinf arction angina.
b. Occurs with an unpredictable degree of
exertion or emotion and increases in
occurrence, duration, and severity over
time.
c. Pain may not be relieved by
rest/nitroglycerin.
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3. VARIANT
ANGINA
a. Also called
PRINZMETAL¶S or
vasospastic angina.
b. Chest pain at rest with
ECG changes due to
coronary artery spasm
c. Attacks may be
associated with ST
segment elevation notedon the
electrocardiogram.
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ASSESSMENT
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1. PAIN
a. Pain can develop slowly or
quickly.
b. Pain usually is described as
mild or moderate.
c. Substernal, crushing,
squeezing pain may occur.d. Pain may radiate to the
shoulders, arms, jaw, neck and
back.
e. Pain usually last less than 5 minutes, however, pain can last
up to 15-20 minutes.
f. Pain is relieved by nitroglycerin
or rest.
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2. Dyspnea
3. Pallor
4. Sweating
5. Palpitations and tachycardia
6. Dizziness and faintness
7. Hypertension
8. Digestive disturbances.
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DIAGNOSTIC STUDIES
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2. STRESS TEST
� Chest pain or changes in the
electrocardiogram or vital signs
during testing may indicate
ischemia.
� Helps show whether enough
blood flows to your heart when
it's working hard. Doctors
usually use stress testing to
help them diagnose coronaryartery disease (CAD) or to see
how serious this disease is in
those who are known to have it.
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3. CARDIAC ENZYMES
AND TROPONINS
� Findings are normal in angina.
� Catheterization provides a
definitive diagnosis by
providing information aboutthe patency of the coronary
arteries.
4. CARDIAC
CATHETERIZATION
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NURSING
INTERVENTIONS
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A. ASSESS PAIN
1. Location: jaw and or arm as well as chest
2. Character
3. Duration: goes away with rest and/or
nitroglycerine (Nitro-bid)
4. Precipitating factors (once identified,
eliminate or minimize to avoid attacks).
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B. Educate the client to help client to adjust
living style to prevent episode of angina
a. Avoid excessive activity in cold weather
b. Avoid overeating
c. Stop smoking
d. Avoid constipation
e. Rest after meals
f. Exercise
g. Decrease stress
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C. Teach client that anything that decreases
cardiac output or increases workload of
heart can cause chest pain.
D. Teach client how to cope with an attack:
use of nitroglycerin ± peripheral
vasodilation decreases myocardial
oxygen demand; coronary artery
vasodilation increases supply of oxygen
to myocardium.
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NITROGLYCERIN
� Nitroglycerin : vasodilators.
� It works by relaxing the blood vessels so
the heart does not need to work as hard
and therefore does not need as much
oxygen.
� When to take: daily to prevent and/or as
needed at onset of chest pain; if lcient
knows an activity can cause pain, should
take before (e.g. Sexual intercourse).� How often: if at onset of attack, every 5
minutes x 3; if client chest pain still not
relieved call 911
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� Stor age: Dark, dry, only good for 3
months.
� Side effects: Headache, hypotension
� Types: tablet, ointment, patch and spray
a. If given daily for prevention, client must be
nitroglycerin free daily for 12 hours to
prevent toleranceb. If patch user: ³on´ upon waking, ³off´ at
bedtime
c. Never take nitroglycerin with out sitting
down and stopping activity.
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CONTRAINDICATIONS FOR
NITRATES
� Hypotension
� Increased intr acr anial pressure
� Severe anemia
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SIDE EFFECTS OF NITRATES
� Headache
� Orthostatic hypotension
� Dizziness, weakness
� Faintness� Nausea, vomiting
� Flushing or pallor
� Conf usion
� Rash� Dry mouth
� Reflex tachycardia
� Par adoxical br adycardia
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CONT....
� Instruct the client to store medications in a
dark, tightly closed bottle
� Instruct the client to check the expiration
date on the medication bottle because
expiration may occur within 6 months of
obtaining medication
� Instruct the client to take acetaminophen
for a headache.
�
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Collater al circulation
� is a network of tiny blood vessels, and,
under normal conditions, not open. When
the coronary arteries narrow to the point
that blood flow to the heart muscle is
limited (coronary artery disease), collateralvessels may enlarge and become active.
This allows blood to flow around the
blocked artery to another artery nearby or
to the same artery past the blockage,protecting the heart tissue from injury.
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CONGESTIVE HEART
FAILURE
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Definition:
� Congestive heart failure(CHF), or heart failure, is acondition in which the heartcan't pump enough blood to
the body's other organs.� Can be one sided or both
sided failure
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ETIOLOGY
A. Narrowed arteries that supply blood tothe heart muscle ² coronary arterydisease
B. Past heart attack, or myocardialinfarction, with scar tissue that interfereswith the heart muscle's normal work
C. High blood pressure
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ETIOLOGY
D. Heart valve disease due to pastrheumatic fever or other causes
E. Primary disease of the heart muscle
itself, called cardiomyopathy.
F. Heart defects present at birth ²congenital heart defects.
G. Infection of the heart valves and/or heartmuscle itself ² endocarditis and/or myocarditis
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As heart's pumping power is weaker than normal,blood moves through the heart and body at a slower r ate, and pressure in the heart increases.
The chamber s of the heart respond bystretching to hold more blood to pump throughthe body. In time, the heart muscle walls weakenand are unable to pump as strongly.
As a result, the kidneys often respond bycausing the body to retain fluid (water) andsodium thus the body becomes congested.
CCF-PATHOPHYSIOLOGY
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When Left ventricle muscle is damaged- itfails to contract/pump with sufficient force
When ventricular fails to circulate blood,
the blood will back up in the lung
Increase pressure in the pulmonarycirculation
Fluid moves into pulmonary tissue andalveoli
PULMONARY EDEMA
LEFT SIDED HEART FAILURE (LVF)
Pulmonary Edema
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Pulmonary Edema
The most severe manifestation of LeftThe most severe manifestation of Left
Heart FailureHeart Failure
Fluid leak into the pulmonary interstitialFluid leak into the pulmonary interstitial
spaces (Pulmonary congestion/edema)spaces (Pulmonary congestion/edema)
Hypoxia and poor 02 exchangeHypoxia and poor 02 exchange
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CLINICAL
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MANIFESTATIONS
(LVF)LEFT VENTRICULAR FAILURE
� Dyspnea
� Orthopnea ± difficulty in breathingat rest or when lying flat in bed(supine position causes the fluid toback up in the lung)
� Cough or wheezing
� Frothy pink sputum
� Cr ackles can be heard in thelungs
� Paroxysmal Nocturnal Dyspnea ±waking up at night short of breath.
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CLINICAL MANIFESTATIONS
(LVF)
� Cerebral hypoxia- result of decreasedcardiac output causes:
Anxiety
Irritability
Restlessness Confusion
Impaired memory
Insomnia
� Nocturia-
� Oliguria-late manifestation
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RIGHT SIDED HEART FAILURE
(RVF)
Edema of the leg, ankles, liver,abdominal cavity
The blood backs up to the tissue, causingcongestion of viscera and peripheral tissue
When Right ventricular fails ,it cannot accept allthe blood returning to the heart
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CLINICAL MANIFESTATIONS
(RVF)
Shortness of breath Swelling of feet and ankles
Urinating more frequently at night
Pronounced neck veins
Palpitations (sensation of feeling the heartbeat)
Irregular fast heartbeat
Fatigue
Weakness
Fainting
Hepatomegaly - liver congestion
Ascites ±due to liver congestion
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� Jugular venous distention
� S3
� Rales
� Pleural effusion
� Edema
� Hepatomegaly
� Ascites
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H t F il Cli i l if t ti
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83
Heart Failure Clinical manifestations :
Pulmonary Congestion (L)
and Systemic Congestion (R)
Right Heart Failure Left Heart Failure
Pulmonary fluid overloadPeripheral fluid overload
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A. Serum electrolytes ,urea & nitrogen
B. Liver function test
C. Arterial blood gases ± to evaluate gasexchange
D. Kidney functions testE. Chest X-Ray ± may show pulmonary
vascular congestion, cardiomegaly
F. ECG ± Ventricular enlargement
G. Echocardiography± to evaluate left
ventricular function
CCF- INVESTIGATIONS
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CCF-MEDICATIONS
to reduce cardiac work and improve cardiac
function
a. Diuretics
b. Beta blockers.
c. Digitalis ±Digoxin
d. Inotropes-Dopamine, Dobutamine
e. Angiotensin ± converting enzyme
inhibitors
NURSING INTERVENTION FOR
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NURSING INTERVENTION FOR
HEART FAILURE
� Assess cardiovascular status, vital sign
and hemodynamic variable to detect signs
of reduced cardiac output.
� Assess respiratory status to detect
increasing fluid in the lungs andrespiratory failure.
� Keep the client in semi-fowler's position to
increase chest expansion and improve
ventilation.
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� Administer medication as prescribed, to
enhance cardiac performance and reduce
excess fluids.
� Administer oxygen to enhance arterial
oxygenation.
� Measure and record intake and output,
Intake greater than output may indicated
fluid retention.
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� Monitor laboratory test result to detect
electrolyte imbalances, renal failure, and
impaired cardiac circulation.
� Provide suctioning, if necessary assist with
turning and encourage coughing and deepbreathing to prevent pulmonary
complication.
� Restrict oral fluid to avoid worsening the
client's condition.
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� Weigh the client daily to detect fluid retention.
A weight gain of 2lb (0,9 kg) in 1 day or 5 lb
(2,3 kg) in 1 week indicates fluid gain.� Measure and record the client's abdominal
girth. An increased in abdominal girth suggests
worsening fluid retention and right-sided heart
failure.� Make sure the client maintains a low-sodium
diet to reduce fluid accumulation.
� Encourage the client to express feelings, such
as a fear of dying to reduce anxiety.
SURGICAL MANAGEMENT
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SURGICAL MANAGEMENT
Heart Tr ansplantation
A heart tr ansplant removes a damaged or
diseased heart and replaces it with a healthy
one.
The healthy heart comes from a donor who has
died. It is the last resort for people with heart
f ailure when all other treatments have f ailed.
The most common procedure is to take a
working heart from a recently deceased organ
donor (allogr aft) and implant it into thepatient. The patient's own heart may either be
removed (orthotopic procedure) or, less
commonly, left in to support the donor heart
(heterotopic procedure).
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� HEART TRANSPLANTATION
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� Heart Transplantation
C di l t
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�CardiomyoplastyThis is a procedure in which
skeletal muscles are taken from a
patient's back or abdomen.
Then they're wrapped around an
ailing heart.
This added muscle, aided by
ongoing stimulation from a device
similar to a pacemaker, may boost
the heart's pumping motion.
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a. Decreased cardiac output
b. Impaired gas exchange
c. fluid and electrolyte imbalance related
to fluid volume excessd. Imbalanced nutrition: less than body
requirements
e. Risk for impaired tissue integrityf. Activity intolerance
g. Sleep pattern disturbance
h. Fear/Anxiety
NURSING DIAGNOSIS
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Assess and record respiratorypattern include rate depth and
rhythm. Observe color of patient ± lips and
nails. Reassure patient during distress
episodes. Put patient in upright position
supported with by pillows-encourage lung expansion.
Breathlessness related to impairedPulmonary gas exchange / impairedgas exchange related to pulmonarycongestion
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Promote rest ± reducesoxygen demand.
Administer Oxygen therapy
Give medication as prescribedto reduce pulmonary edema.-Diuretics
Strict intake and output chart
DECREASED CARDIAC
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Assess patient for sign of decreased cardiac output-e.g.
confusion, dizziness, irritability
Vital sign ±BP,PR & Spo2monitoring
ECG monitoring-monitor for sign
of dysrhythmiasMonitor lung sound-sign of
crackles & coughing
DECREASED CARDIACOUTPUT
DECREASED CARDIAC
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DECREASED CARDIACOUTPUT
Monitor IO -detect sign of reduced
renal perfusion
Medication as prescribed to
increase myocardial contractility- e.gDopamine, Digoxin
Promotes rest to reduce myocardial
workload & oxygen demand
SELF CARE DEFICIT RELATED TO
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Assess and record patient¶s level of tolerance to
activities of daily living.
Encourage patient to verbalize activities that
increase fatigue or shortness of breath. Provide rest period between and during
activities
Keep frequently used items within reach of
patient. Give encouragement and promotes
independence in activities within patient¶s limit.
Assist patient in activities of daily living.
SELF CARE DEFICIT RELATED TOFATIGUE / SHORTNESS OF
BREAT H
IMPAIRED SKIN INTEGRITY
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Assess and record skin integrity.
Lift correctly to avoid dragging on the
patient¶s skin. Use pressure relieving mattress as necessary.
Encourage patient to move position frequently
If she/ he is unable to do so, assist patient in
changing position every 4 hourly and gentlymassage pressure area to promote bloodcirculation.
IMPAIRED SKIN INTEGRITYRELATED PH YSICALIMMOBILITY.
Impaired skin integrity
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Ensure bedclothes are smooth andfree from crumbs.
Change pampers or bed sheet whensoiled.
Keep skin clean and dry at all time.
Impaired skin integrityrelated physicalimmobility.
INADEQUATE NUTRITIONAL
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Assess nutritional status.
Record all intake and output chartstrictly.
Observe and record for nausea andvomiting.
Note vomitus for frequency, amount
and color. Refer to dietitian
Advise on dietary supplements
Avoid process and canned food.
QINTAKE RELATED TO LOSS
OF APPETITE
INADEQUATE
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Offer small and frequent diet.
Plan meals with patient and dietitian.
Assist patient with meals as needed.
Ensure pleasant environment during
meals. Soft diet as tolerated.
INADEQUATENUTRITIONAL INTAKE
RELATED TO LOSS OFAPPETITE
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ANEURYSM
� An aneurysm (AN u rism) is described as a
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� An aneurysm (AN-u-rism) is described as a
permanent bulging and stretching of an artery,
in which the dilation is two times or greater the
size of the artery. This balloon-like bulge
abnormality develops a weakness in the arterial
wall and puts the patient at risk for serious
complications.
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PATHOPHYSIOLOGY
� Degenerative changes in the muscular
layer of the aorta create a focal weakness,
allowing the inner and outer layer to
stretch outward.
� Blood pressure within the aortaprogressively weakens the vessel walls
and enlarges the aneurysm
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Types of aneurysm
1. Aortic aneurysms
2. Cerebral aneurysms
3. Peripheral aneurysms.
The two types of aortic aneurysm area.
a. Thoracic aortic aneurysm (TAA)
b. Abdominal aortic aneurysm (AAA).
Factors that increase the risk for aneurysm
include:
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include:1. Atherosclerosis, a buildup of fatty deposits in the arteries.
2. Smoking. People who smoke are eight times more likely to develop ananeurysm.
3. Overweight or obesity: A family history of aortic aneurysm, heart disease,
or other diseases of the arteries.
� Certain diseases that can weaken the wall of the aorta, such as:
a. Marfan syndrome (an inherited disease in which tissues don't developnormally)
b. Untreated syphilis (a very rare cause today)
c. Tuberculosis (also a very rare cause today)
4. Trauma such as a blow to the chest in a car accident.5. Severe and persistent high blood pressure between the ages of 35 and 60.
This increases the risk for a cerebral aneurysm.
6. Use of stimulant drugs such as cocaine.
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I. Abdominal Aortic Aneurysms
Abdominal Aortic
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Abdominal Aortic
Aneurysm
� An abnormal dilation in the arterial
wall, most commonly occurs in the
aorta between the renal arteries
and iliac branches.
TYPES
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1. FUSIFORM: Diffuse dilation that
involves the entire circumferenceof the arterial segment
2. SACCULAR: Distinct localized out
pouching of the artery wall
3. DISSECTING: Created when
blood separates the layers of theartery wall, forming a cavity
between them
4. FALSE (pseudoaneurysm):
a. Pseudoaneurysm occurs when the
clot and connective tissue areoutside the arterial wall
b. Pseudoaneurysm occurs as a
result of vessel injury or trauma to
all three layers of the arterial wall.
M t bd i l ti (AAA ) d l
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Most abdominal aortic aneurysms (AAAs) develop
slowly over years. They often don't have signs
or symptoms unless they rupture. If you have an AAA, your doctor may feel a throbbing mass
while checking your abdomen.
When symptoms are present, they can include:
a. A throbbing feeling in the abdomen
b. Deep penetrating pain in your back or the side
of your abdomen
c. Steady, gnawing pain in your abdomen thatlasts for hours or days
d. Coldness, numbness, or tingling in the feet due
to blocked blood flow in the legs
If an AAA r uptures, symptoms can include
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p y p
sudden, severe pain in your lower
abdomen and back
a. nausea (feeling sick to your stomach) and
vomiting
b. clammy, sweaty skin; lightheadedness;
c. a rapid heart rate when standing up.
d. Internal bleeding from a ruptured AAA can
send you into shock. This is a life-threatening
situation that requires emergency treatment.
II Th i A ti A
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II. Thor acic Aortic Aneurysms
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II. Thor acic Aortic Aneurysms
Thoracic aortic aneurysm (TAA) may not
cause symptoms until it dissects or grows
large. Then, symptoms may include:
a.Pain in your jaw, neck, back, or chest
b.Coughing, hoarseness, or trouble breathing
or swallowing.
III Cerebral Aneurysm
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III. Cerebr al Aneurysm
If a cerebral (brain) aneurysm presses on
nerves in the brain it can cause signs and
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nerves in the brain, it can cause signs and
symptoms. These can include:
A droopy eyelid Double vision or other changes in
vision
Pain above or behind the eye
A dilated pupil
Numbness or weakness on one side of
the face or body
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IV Peripheral Aneurysm
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IV. Peripher al Aneurysm
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Signs and symptoms of peripher al
aneurysm may include:
A pulsating lump that can be felt in the
neck, arm, or leg.
Leg or arm pain, or cramping with exercise
Painful sores on toes or fingers.
Gangrene (tissue death) from severely
blocked blood flow in the limbs.
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An aneurysm in the
popliteal artery (behind the
knee) can compress
nerves and cause pain,
weakness, and numbness
in the knee and leg.
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DIAGNOSTIC PROCEDURE
1. Abdominal or chest X-rays may show
calcification that outlines the aneurysm.
2. CT scan and ultrasonography are used to
detect and monitor size of aneurysm.
3. MRI or magnetic resonance angiographyfurther evaluate circulation.
4. Arteriography allows visualization
of aneurysm and vessel.
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Surgical Interventions:
� Surgery may be required to remove the
aneurysm and restore vascular continuity
with a bypass graft.
� Complications of surgery include arterial
occlusion, graft hemorrhage, infection,ischemic colon, and impotence.
� Endovascular grafting using stent inserted
via catheter through the femoral artery
may be warranted.
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NURSING INTERVENTIONS
1. Monitor for signs and symptoms of spinal cord ischemia
such as pain, numbness, paresthesia, and weakness
caused by dissection.
2. Monitor for signs of stroke or cardiac tamponade caused
by dissection.
3. Postoperatively, monitor vital signs continuously.
4. Check extremities for sensation, temperature, pulses,
color, capillary refill, and petechiae.
5. Monitor for bleeding from the wound and for signs of hemorrhage, hypotension, tachycardia, pallor, and
diaphoresis.
6. Monitor temperature and incision for signs of
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p g
infection.
7. Monitor urinary output hourly.8. Administer antibiotics, if ordered, to prevent
infection.
9. Administer pain medication, as ordered, or
monitor patient-controlled analgesia.
10.Elevate the head of the bed no more than 45
degrees for first 3 days postoperatively to
prevent pressure on the repair graft site.
7. Warn patient not to cross legs or sit for long
i d t t th b f ti
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periods to prevent thrombus formation.
8. Teach the patient about blood pressuremedications and the importance of taking them
as prescribed.
9. Teach the patient to recognize and report signs
and symptoms of an expanding aneurysm or rupture.
10.Encourage adequate nutritional intake to
enhance wound healing.
11.Teach the patient to maintain a
postoperative exercise regimen.