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NCM106 AcuteBiologicCrisis
NCM106 AcuteBiologicCrisis
Adapt.
Overcome.
CEFI is now ready.
KENNETH P. VELUYA
College of Nursing
Acute Biologic Crisis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
MANAGEMENT OF PATIENTS WITH
CORONARY VASCULAR
DISORDERS
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Learning Objectives:
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Learning Objectives:
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Learning Objectives:
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Walls of Arteries and Veins
• Tunica Externa/Adventitia
– Outermost layer
– CT w/elastin and collagen
– Strengthens, Anchors
• Tunica Media
– Middle layer
– Circular Smooth Muscle
– Vaso-constriction/dilation
• Tunica Intima
– Innermost layer
– Endothelium
– Minimize friction
• Lumen
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Artery / Vein Differences
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
Dyspnea
• Subjective feeling (inability to get enough air).
• Dyspnea on exertion is due to increased O2
myocardial demand.
• Orthopnea is related to blood pooling
in the pulmonary bed; suspect Pulmonary
Edema
• Any sudden or acute dyspnea may be a sign
of Pulmonary Embolism
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Chest tightness
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
Cough / Sputum
• Mucoidal and/or Foamy
sputum can be a sign of CHF
• Pink-tinged frothy appearance may signal
Pulmonary Edema.
• Whitish, viral infection
• Change in color other than the above
mentioned may signify bacterial infection
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
Cyanosis
• Bluish discoloration of the skin and
mucous membrane
• Sat O2 is below 90%
Fatigue
• May be due to Anemias or related to
decreased Cardiac Output
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
Palpitations
• Awareness of rapid or irregular heart beat
• Autonomic Nervous System and Adrenal
Glands response (stress)
Syncope
• Transient loss of consciousness
• Due to decreased cerebral
tissue perfusion
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Types of Edema
• Bilateral edema
=CHF or Renal Failure
• Unilateral edema
=Vascular or Lymphatic
obstruction
• Non-pitting edema
=Inflammatory
• Pitting edema =HP and
COP derangement
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
Skin
• Color, temperature, hair growth, nails, capillary
refill
• spooning of fingers /clubbing of fingers
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
Serum Enzymes Studies
• Lactic Dehydogenase (LDL)- Onset:
12hrs;Peak: 48hrs; returns to normal: 10-14
days4. Hydroxybuterate
• Dehydroxynase (HBD)- it is valuable in
detecting silent MI because it is elevated for a
long period of time. Onset: 10-12hrs; Peaks: 48-
72hrs; Returns to Normal 12-13 days
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Laboratory & Diagnostic Test
Hemodynamic Monitoring
• Swan-Ganz Catheterization
• Right side of the heart
• Pulmonary artery pressure
• Pulmonary artery occlusive pressure
• Right atrial pressure
• Cardiac output
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Swan-Ganz Catheterization
Laboratory & Diagnostic Test
Coronary Angiogram
• allows to visualize narrowings or
obstructions
• therapeutic measures can follow
immediately.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Artery Disease
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Artery Disease
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Artery Disease
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
CORONARY
ATHEROSCLEROSIS
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
• Atheromas / Plaques
– Consist of lipids, cells,
fibrin, cell debris
– Lipids usually
transported with
lipoproteins
– Deposited in the intima
of the arterial wall
– Initiated by smoking,
hypertension and other
lifestyle factors
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Pathophysiology:
• Fatty streaked formation in the vascular
intima→ T-cells and monocytes ingest lipids
in the area of deposition→ Atheroma
formation→ narrowing of the arterial
lumen→ reduced blood flow→ myocardial
infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
ATHEROSCLEROSIS
- narrowing of artery
- lipid or fat deposits (plaques)
- tunica intima
ARTERIOSCLEROSIS
- hardening of artery, thicken
- calcium and protein deposits
- tunica media
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Predisposing Factors:
1. Sex – male
2. Race – black
3. Smoking
4. Obesity
5. Hyperlipidemia
6. Sedentary lifestyle
7. Diabetes Mellitus
8. Hypothyroidism
9. Diet – increased saturated fats
10. Type A personality
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Risk factors:
- Age: 30-50 y.o.; Male (55), Female (65)
- Gender: Males and Post-Menopausal Females
(HRT)
- Race: Non-whites has higher mortality rates
- Family History of CAD
- Hypertension, DM
- Smoking, Obesity
- Sedentary Lifestyle
- Hyperlipidemia, Elevated Uric Acid Levels
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Clinical Manifestations:
• Signs and symptoms would vary depending
on the location, degree of narrowing and
obstruction of the arterial lumen.
• Deprivation of heart muscle cells will result
in Myocardial Ischemia.
• Chest pain brought about by myocardial
ischemia is known as Angina Pectoris.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Clinical Manifestations:
• Sudden decrease of the blood to the heart
may cause Sudden Cardiac Death
• Typical S/Sx: Dyspnea, Nausea, Weakness,
SOB
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Prevention:
• Correction of Cholesterol Abnormalities
• Cessation of Cigarette Smoking
• Management of Hypertension
• Control of Diabetes Mellitus
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Dietary Measures:
• Referral to Registered Dietician
• Intake of 20 to 30mgs of soluble dietary fiber
such as fresh fruits, cereal grains, vegetables
and legumes
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Physical Activity:
• Regular moderate physical activity at least 30
mins., 3-4 times per week
• Start and end activity with a 5 min. stretching
exercise
• Stop when adverse signs or symptoms appear
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Management of Hypertension:
• Prolonged hypertension will result to the
stiffness of the vessel walls, leading to injury
and inflammation of the intima.
• Increased workload of the heart can also result
in the enlargement and thickening of the heart
which may lead to heart failure.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Treatment Regimen:
• Decrease total cholesterol, HDL, LDL
and triglycerides
• Manage hypertension
• Control diabetes
• Quit smoking
• Oral anticoagulant
• Exercise
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Medications:
– 3-Hydroxy-3-Methylglutaryl coenzyme A (HMG-CoA)
e.g. atorvastatin (Lipitor); simvastatin (Zocor)
– Nicotic acids - niacin (Niacor, Niaspan)
– Fibric Acids – fenofibrate (Tricor)
– Bile Acid Sequestrants – cholestyramine (LoCholest)
Surgical intervention:
– Percutaneous transluminal coronary angioplasty (PTCA)
– Cardiac catheterization
– Laser beam technology
– Coronary artery bypass grafting
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Objectives of PTCA:
1. Revascularize myocardium
2. To prevent angina
3. Increase survival rate
- Done to single occluded vessels
- If there is 2 or more occluded blood vessels
CABG is done
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
Laser Therapy:
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Coronary Atherosclerosis
3 Complications of CABG:
1. Pneumonia – encourage to perform deep
breathing, coughing exercise and use of
incentive spirometer
2. Shock
3. Thrombophlebitis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
ANGINA PECTORIS
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
• A clinical syndrome usually
characterized by episodes of chest pain
or pressure on the anterior chest
• Caused by insufficient coronary blood
flow resulting in a decreased oxygen
supply where there is increased
myocardial demand for oxygen supply in
response to physical exertion or
emotional stress
• “the need for oxygen exceeds the
supply”
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Types of Angina Pectoris:
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Types of Angina Pectoris:
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Pathophysiology:
• Coronary blood flow becomes
inadequate to meet myocardial oxygen
demand → myocardial ischemia →
myocardial cells alter from aerobic to
anaerobic metabolism producing
chemical end products → a progressive
impairment of metabolic, mechanical and
electrical functions → angina pectoris
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Risk factors:
• Atherosclerosis, CAD
• Men are high risk, Increasing age
• Hypertension, Hypercholesterolemia
• DM
• Thromboangitis obliterans
• Severe anemia
• Aortic insufficiency
• Smoking, Sedentary lifestyle
• Family history of premature ischemic heart
disease
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Predisposing Factors:
1. Sex – male
2. Race – black
3. Smoking
4. Obesity
5. Hyperlipidemia
6. Sedentary lifestyle
7. Diabetes Mellitus
8. Hypothyroidism
9. Diet – increased saturated fats
10. Type A personality
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Potential Complications:
• Acute pulmonary edema
• Congestive heart failure
• Cardiogenic shock
• Dysrhythmias and cardiac arrest
• MI
• Myocardial rupture
• Pericardial effusion and cardiac tamponade
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Precipitating Factors: 4E’s
• Exertion - physical exertion
• Eating - consumption of a heavy meal
• Extreme Temperature - very cold or very
hot
• Excitement - strong emotions and sexual
activity
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Assessment of Angina Pectoris:
• P – Position/ Location and Provocation
• Q – Quality/ Quantity
• R – Radiation/ Relief
• S – Severity/ Symptoms
• T – Timing
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Assessment:
• Chest pain
• Mild indigestion
• Choking or heavy sensation in the upper
chest that ranges from discomfort to
agonizing pain
• Pain is poorly localized, Unrelieved by
rest and NTG
• Dyspnea, diaphoresis, nausea and
vomiting, cold clammy skin, anxiety,
dizziness and syncope
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Signs and Symptoms:
1. Levine’s Sign – initial sign that shows the hand
clutching the chest
2. Chest pain characterized by sharp stabbing pain
located at sub sterna usually radiates from back,
shoulder, arms, axilla and jaw muscles, usually
relieved by rest or taking nitroglycerine
3. Dyspnea
4. Tachycardia
5. Palpitations
6. Diaphoresis
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Diagnostic Procedure:
1. History taking and physical exam
2. ECG tracing reveals ST segment
depression
3. Stress test – treadmill test, reveal
abnormal ECG
4. Serum cholesterol and uric acid is
increased
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Nursing intervention:
• Monitor VS, ABG, ECG, O2
• Provide health teaching
• Minimize precipitating events
• Provide dependent nursing intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Treatment:
• Nitroglycerin tablets: SL; up to 3 tablets every
5 mins within 15 mins
• Reduce stress, anxiety; Avoid exertion,
extreme temperatures (4E’s)
• Avoid smoking, Maintain a low cholesterol, low
saturated fat diet
• Exercise
• Maintain bed rest, Avoid Straining
• Place on semi or high fowler’s position
• O2 at 2LPM
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Nursing Management:
1. Enforce complete bed rest
2. Administer medications as ordered
a. Nitroglycerine (NTG) – when given in small doses
will act as venodilator, but in large doses will act as
vasodilator
- Give first dose of NTG (sublingual) 3 – 5 minutes
- Give second dose of NTG if pain persist after giving first
dose with interval of 3 - 5 minutes
- Give third and last dose of NTG if pain still persists at 3
– 5 minutes interval
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Nursing Management when giving NTG
- Keep the drug in a dry place, avoid moisture
and exposure to sunlight as it may inactivate the
drug
- Monitor side effects
• Orthostatic hypotension
• Transient headache and dizziness
- Instruct the client to rise slowly from sitting
position
- Assist or supervise in ambulation
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
b. Beta-blockers
- (lol)
- Propanolol - side effects PNS – broncho constriction, vasodilation
- Not given to COPD cases because it causes Bronchospasm
c. ACE Inhibitors
- (pril)
- Enalapril, captopril
d. Calcium Antagonist
- calcibloc
- Nifedipine, diltiazem
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Pharmacologic Treatment:
• Nitrates: dilate the coronary arteries, reduces O2
requirements of the heart (Isosorbide Dinitrate,
NTG)
• Anticoagulants : prevent thrombus formation
(Aspirin, Clopidogrel, Heparin)
• Beta-blockers: reduces BP and HR (Propranolol,
Metoprolol, Acebutolol)
• Calcium channel blockers: dilate coronary artery
and reduce vasospasm, lowers HR (Diltiazem,
Nifedipine, Verapamil, Amlodipine)
• Laxatives: lessens constipation and straining
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Nursing Diagnoses:
• Ineffective myocardial tissue perfusion secondary
to CAD, as evidenced by chest pain or equivalent
symptoms
• Anxiety related to fear of death
• Deficient knowledge about the underlying disease
and methods for avoiding complications
• Noncompliance, ineffective management of
therapeutic regimen related to failure to accept
necessary lifestyle change
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
Expected Patient Outcomes:
1. Reports that pain is relieved promptly
a. Recognizes symptoms
b. Takes immediate action
c. Seeks medical assistance if pain persists
2. Reports decreased anxiety
a. Expresses acceptance of diagnosis
b. Expresses control over choices within medical
regimen
c. Does not exhibit signs and symptoms that
indicate a high level of anxiety changes in quality
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Angina Pectoris
3. Understands ways to avoid complications and
demonstrates freedom from complications
a. Describes the process of angina
b. Explains reasons for measures to prevent
complications
c. Exhibits normal ECG and cardiac enzyme levels
d. Experiences no signs and symptoms of acute MI
4. Adheres to self-care program
a. Takes medications as prescribed
b. Keeps health care appointments
c. Implements plan for reducing risk factors
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
ACUTE MYOCARDIAL INFARCTION
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
• Death of myocardial tissue in regions of
the heart with abrupt interruption of
coronary blood supply brought about by
inadequate oxygenation and is often
caused by sudden, complete blockage
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Types
1. Transmural Myocardial Infarction – most
dangerous type characterized by occlusion of
both right and left coronary artery
2. Subendocardial Myocardial Infarction –
characterized by occlusion of either right or
left coronary artery
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Pathophysiology: AMI
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
1. Sex – male
2. Race – black
3. Smoking
4. Obesity
5. Hyperlipidemia
6. Sedentary lifestyle
7. Diabetes Mellitus
8. Hypothyroidism
9. Diet – increased saturated fats
10. Type A personality
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Modifiable Risk Factors of AMI:
• Stress • Hyperlipidemia
• Diet • Diabetes Mellitus
• Exercise • Obesity
• Cigarette Smoking • Personality Type or
• Alcohol Behavioral Factors
• Hypertension • Contraceptive Pills
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Signs and Symptoms
1. Chest pain
- Excruciating visceral, viselike pain located at substernal
and rarely in precordial
- Usually radiates from back, shoulder, arms, axilla, jaw and
abdominal muscles (abdominal ischemia) and hands
- Not usually relieved by rest or by nitroglycerine
2. Dyspnea
3. Increase in blood pressure (initial sign)
4. Hyperthermia
5. Ashen skin (pale), cool, clammy, diaphoretic
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Assessment:
- Chest pain: severe, persistent, crushing,
substernal discomfort
- Dyspnea, rales or crackles
- Increased BP then gradual drop in BP
- Diaphoresis, cold clammy skin, N/V, elevated
temperature, anxiety
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
1. Cardiac Enzymes
a. CPK – MB
- Creatinine phosphokinase is increased
- Heart only, 12 – 24 hours
b. LDH – Lactic dehydroginase is increased
c. SGPT – Serum glutamic pyruvate transaminase is
increased
d. SGOT – Serum glutamic oxal-acetic transaminase
is increased
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
2. Troponin Test – is increased (protein in
myocardial)
3. ECG tracing reveals
a. ST segment elevation
b. T wave inversion
c. Widening of QRS complexes indicates that there
is arrhythmia in MI
4. Serum Cholesterol and uric acid are both
increased
5. CBC – increased WBC
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Diagnostic Tests:
-ECG: Elevated ST segments, T wave inversion, Q
wave presence
-Myocardial Enzymes: Increased Troponin T and I,
CK-MB, LDH and myoglobin
-Blood tests: Elevated WBC, Elevated erythrocyte
sedimentation rate (ESR), elevated serum
cholesterol, alanine aminotransferase (AST)
-Exercise stress test
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Nursing Management
Goal: Decrease myocardial oxygen demand
1. Decrease myocardial workload (rest heart)
- Administer narcotic analgesic/morphine sulfate
- Side Effects: respiratory depression
- Antidote: Narcan/Naloxone
- Side Effects of Naloxone Toxicity is tremors
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
b. Anti Arrythmic Agents
- Lidocaine (Xylocane
- Side Effects: confusion and dizziness
- Brutylium
c. Beta-blockers
- (-lol)
d. ACE Inhibitors
- (-pril)
e. Calcium Antagonist
- amlodipine, verapamil, diltiazem
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
g. Anti Coagulant
- Heparin (check for partial thrombin time)
- Antidote: protamine sulfate
- Coumadin/ Warfarin Sodium (check for
prothrombin time)
- Antidote: Vitamin K
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
h. Anti Platelet
- PASA (Aspirin)
- Anti thrombotic effect
- Side Effects of Aspirin
• Tinnitus
• Heartburn
• Indigestion/Dyspepsia
- Contraindication
• Dengue
• Peptic Ulcer Disease
• Unknown cause of headache
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
10. Provide client health teaching and discharge planning
concerning
a. Avoidance of modifiable risk factors
- Arrhythmia (caused by premature ventricular contraction)
b. Cardiogenic shock
- late sign is oliguria
c. Left Congestive Heart Failure
d. Thrombophlebitis
- homan’s sign
e. Stroke/CVA
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
g. Resumption of ADL particularly sexual intercourse is 4 – 6
weeks post cardiac rehab, post CABG and instruct to
- make sex as an appetizer rather than dessert
- instruct client to assume a non weight bearing position
• Client can resume sexual intercourse if can climb staircase
- dietary modification
h. Strict compliance to mediation and importance of follow up
care
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Nursing Intervention:
1. Monitor VS: ECG, blood test, physical
assessment, MIO
2. Minimize anxiety
3. Minimize metabolic demands: soft diet, low salt,
low cholesterol, low fat
4. O2 at 2LPM
5. Provide health teaching: MI, healing process,
treatment regimen
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Pharmacology:
- Nitrates, thrombolytics, aspirin, ACE inhibitors,
anticoagulants
- Stool softeners, hypolipidemics
- Analgesics: morphine sulfate (drug of choice)
- MONA: Morphine, Oxygen, Nitroglycerin,
Aspirin
Surgical:
-Percutaneous Transluminal Coronary Angioplasty
-Coronary Artery Bypass Graft (CABG)
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Health teaching:
-Effects of MI, healing and treatment
-Medication, risk factors, diet: low sodium, low
cholesterol, no caffeine
-Resumption of sexual activity: 4-6 weeks or could
tolerate an exercise of 3-4mph or could climb a
flight of stairs without difficulty
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
MI management: MONA
Morphine
O2
Nitroglycerine
Aspirin
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiovascular Assessment
Chest Pain
• Most common
• Due to Ischemia or MI
• Precipitated by stress or can be
relieved by Nitroglycerin (NTG)
• In MI, it is more intense,
unrelated to activities and can’t
be relieved by NTG
• If it occurs during breathing,
suspect respiratory problems
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Acute Myocardial Infarction
Rough diagram of pain zones in myocardial infarction
(dark red = most typical area, light red = other possible
areas, view of the chest).
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Goal of Treatment
• Pain relief
• Reduction of myocardial oxygen
consumption
• Prevention and treatment of complications
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
IV Fluids:
• D5W to KVO
• If unable to take food/fluid per orem
• 1000ml/8 hours
• K supplement
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Pain Medication:
• Morphine SO4
• (2-5mg/IV dose)
• Potent analgesic
• Peripheral venous vasodilation
• Pulmonary venous distention
• Inferior wall MI: may increase vagal
discharge
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Tranquilizers:
• To decrease anxiety
• Diazepam (5-10 mg per IV/orem)
Laxatives:
• To prevent straining during defecation
• Lactulose (HS)
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Nursing Consideration:
• Assess Pulse Rate before administration; with hold
if bradycardia is present.
• Administer with food, may cause GI upset.
• Do not administer with asthma it causes
Bronchoconstriction.
• Do not give to patient with DM, it causes
hypoglycemia.
• Antidote for Beta Blocker poisoning is Glucagon
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Nitrates:
• Act by augmenting perfusion at the border of ischemic zone.
• Generalized vasodilation
• Reducing myocardial O2 demand
• Lowering preload
• Lowering afterload
• Ex: IV Nitroglycerine,
Sublingual Niotroglycerine,Oral/Transdermal Nitroglycerine
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Nursing Considerations:
• Only a maximum of 3 doses at 5 min. interval.
• Offer sips of water before giving it sublingually.
• Store the medication in a cool, dry place; use dark
/amber container.
• If side effects is noticed do not discontinue the drug
this is usual in the first few doses of medication.
• Rotate skin sites for nitro patch.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
ACE inhibitors:
• reduce mortality rates after MI.
• Administer ACE inhibitors as soon as possible
• ACE inhibitors have the greatest benefit in
patients with ventricular dysfunction.
• Continue ACE inhibitors indefinitely after MI.
• Angiotensin-receptor blockers may be used as an
alternative adverse effects, such as a persistent
cough.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Nursing Considerations:
• Assess for signs and symptoms of Bleeding.
• Avoid straining at stool to avoid rectal bleeding.
• It should be given with food.
• Observe for toxicity- Tinnitus (ringing of ears).
• May cause Bronchoconstriction- Observe
for wheezing.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Heparin:
• Assess for S/Sx of Bleeding.
• Keep Protamine Sulfate available.
• If used SQ. do not aspirate to prevent
hematoma formation.
• Monitor for PTT or APTT
• Used for a maximum of 2 weeks.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Thrombolytic therapy:
• Effectiveness highest in the first 2 hours
• After 12 hours, the risk associated with
thrombolytic therapy outweighs any benefit
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Contraindicated:
• unstable angina and NSTEMI
• and for the treatment of individuals with
evidence of cardiogenic shock
• streptokinase, urokinase, and alteplase
(recombinant tissue plasminogen activator ,
rtPA),reteplase,tenecteplase
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Drugs
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Surgical Care:
• Percutaneous Transluminal Coronary Angioplasty -
treatment of choice
• PCI provides greater coronary patency
• lower risk of bleeding and instant knowledge about the
extent of the underlying disease.
• A specially designed balloon – tipped catheter is inserted
under fluoroscopic guidance and advance to the site of the
obstruction.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Intravascular Stenting
• Biologic Stent is produced through
coagulation of collagen, ellastin and other
tissues in the vessel wall by
laser, photocoagulation or radio frequency.
• It is done to prevent restenosis
after Percutaneous Transluminal Coronary
Angioplasty.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Surgical Care
• Percutaneous Transluminal Coronary
Angioplasty
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Emergent or Urgent
Coronary Artery Graft Bypass Surgery
• (CABG) is indicated if angioplasty fails
• Severe narrowing of 1 or more coronary
artery.
• Commonly used: Saphenous vein and
internal mammary artery.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Intervention
Complications
• Inflammation
• Mechanical
• Electrical abnormalities
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiac Rehabilitation
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiac Rehabilitation
Activities:
• Exercise may gradually implemented from
the hospital onwards.
• Exercise session is terminated if anyone of
the following occurs: cyanosis, cold sweats,
faintness, extreme fatigue, severe dyspnea,
pallor, chest pain, PR more than 100/ min.,
dysrhythmias greater than 160/95mmHg.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiac Rehabilitation
Teaching and Counseling
• Self management education guide.
• Control hypertension with continued medical
supervision.
• Diet
• Weight reduction program
• Progressive exercise
• Stress management techniques
• Resumption of sexual activity after 4-6 weeks from
discharge, if appropriate.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Cardiac Rehabilitation
Teaching guide on resumption of sexual
activities:
• Assume less fatiguing position.
• The non- MI partner take the active role
• Take nitroglycerine before sexual activity
• If dyspnea, chest pain or palpitations occur,
moderation should be observed; if
symptom persist stop sexual activity
• Develop other means of sexual expression.
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
YOU ARE GOING TO EXPERIENCE A
HEART ATTACK IN..
3
2
1
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
QUIZ NO. 1
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Questions???
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
Thank you and Good Day!
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.