Medical Surgical Nursing 1 (T) Course Specification 2024-2025 PDF

[email protected] [email protected] [email protected] Tanta University Faculty of Nursing Medical Surgical Nursing Department ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄ...

[email protected] [email protected] [email protected] Tanta University Faculty of Nursing Medical Surgical Nursing Department ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Book of Medical Surgical 2024/2025 2024/2025 2024/2025 Nursing I Second Year Nursing Students Second level- Third Semester Prepared by: Staff of Medical Surgical Nursing Department Academic year: 2024-2025 1  [email protected] [email protected] [email protected] Table of contents Contents 1- Nursing Process 2- Cardiovascular system 3- Respiratory system 4- Gastro-intestinal system ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 5- Cancer 6- Organ transplantation 7- Burn 2024/2025 2024/2025 2024/2025 2  [email protected] [email protected] [email protected] Staff members 1- prof. Dr Nagwa Ragab Atia 2- Prof. Dr/ Hend El-Azazy 3- prof Dr. / Om Ebrahiem Ali Alsaay 4- Prof. Dr. / Afaf Abd Elaziz Basal ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 5- prof.Dr. / Amany Lotfy Abed elaziz 6- prof.Dr. / Seham Ahmed Abed El-Hay 7- prof. Dr Monera El-Shemy 8- Assist prof. Dr Fatma Abbas 9- Assist prof. Dr Reda Abd Elsalam 10- Assist prof. Dr Amany Kamal 2024/2025 2024/2025 2024/2025 11- Dr. Mariem El-Shafeay 12- Dr. shymaa Khalil 13- Dr. Alyaa Waheid 14- Dr Rania Gamal 15- Dr Asmaa Lasheen 3  [email protected] [email protected] [email protected] ‫انشؤَح وانشسانح انخاصح تكهُح انرًشَض‬ :‫سؤَح انكهُح‬ ً ًِ‫االبذاع ًانتًْز ػهَ انًستٌٍ انًحهَ ًاإللهًِْ فِ يزبالث انتؼهْى ً انتؼهى ًانبحج انؼه‬.‫خذيت انًزتًغ‬ Creativity and excellent at local and regional level in the areas of teaching and learning, scientific research, and community service and development ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ environment. :‫سسانح انكهُح‬ ‫تيذف كهْت انتًرّض ربيؼت طنطب انَ بنبء بْئت اكبدًّْت فبػهت تؤدٍ انَ خرّذ ىْئت تًرّض‬ ‫ لبدرة ػهَ خذيت انًزتًغ ًحم‬,ًِ‫يتًْزة تنبفس فَ سٌق انؼًم ػهَ انًستٌٍ انًحهَ ًانؼبن‬ ‫يشبكهو انصحْت ين خالل االبحبث انؼهًْت انتًرّضْت فِ ضٌء لْى انًزتًغ ًتمبنْذه‬. College of nursing Tanta university aimed to building an effective academic environment that is conductive to graduate nursing distinct 2024/2025 2024/2025 2024/2025 body compete in the work at the local level and the global market, able to serve the community and solving health problems through nursing research in the light of the values and traditions of society 4  ‫‪[email protected]‬‬ ‫‪[email protected]‬‬ ‫‪[email protected]‬‬ ‫انشؤَح وانشسانح واالهذاف انخاصح تقسى انرًشَض انثاطنٍ وانجشاحٍ‬ ‫انشؤَه‪:‬‬ ‫ّتطهغ لسى انتًرّض انببطنِ ًانزراحِ بكهْت انتًرّض ربيؼت طنطب انِ تبٌء يكبنت رّبدّو فِ‬ ‫تؼهْى انتًرّض نهًرحهت انزبيؼْت ًانذراسبث انؼهْب بْن كبفت االلسبو انؼهًْت انًختهفت فِ انكهْت‬ ‫ًانكهْبث انًًبحهت ػهِ انًستٌُ انًحهِ ًاإللهًِْ نْتألهى يغ يتطهببث انًزتًغ ًيتغْراث نظبو‬ ‫انرػبّت انصحْت كًب ّسؼِ انمسى انِ تٌفْر بْئت تؼهًْْت تًكن انطبنب‪/‬انطبنبت ًأػضبء ىْئو‬ ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ ‫انتذرّس ين تحمْك احتْبربتيى انتؼهًْْت ًانبحخْت ًانتطٌّرّت‪.‬‬ ‫سسانح انقسى‪:‬‬ ‫تكًن رسبنت لسى انتًرّض انببطنِ ًانزراحِ فِ ارسبء انذػبئى االسبسْت نذراست انتًرّض‬ ‫ػهِ انًستٌُ انزبيؼِ ًانذراسبث انؼهْب ًتخرّذ طهبو يؤىهْن ػهًْب نًًبرسو يينو انتًرّض‬ ‫نهتًكن ين انمْبو ببنرػبّت انتًرّضْت انشبيهو االينو ًانفؼبنت ًانتٌػْت انصحْت فِ انًرافك‬ ‫انصحْت انًختهفت فِ انًزتًغ ًأّضب تنًْو لذراتيى االدارّو ًانمْبدّت ًيشبركت انمسى ين خالل‬ ‫انخرّذ فِ تؼزّز انذًر االكبدًِّ نتطٌّر يينو انتًرّض بًختهف انخذيبث انصحْت كبنمْبو‬ ‫بأبحبث يْذانْو ًحْمت انصهت بؼهٌو انتًرّض انًختهفت ًانًبنْت ػهِ احتْبربث انًزتًغ ‪.‬‬ ‫االهذاف‬ ‫ًيؼرفْب ًاخاللْب نرػبّت انًرضِ االصحبء فِ‬ ‫‪2024/2025‬‬ ‫طبنب‪ /‬طبنبت يؤىهت ػهًْب ًاكبدًّْب‬ ‫‪2024/2025‬‬ ‫‪.1‬تخرّذ‬ ‫‪2024/2025‬‬ ‫شتِ انًزبالث ًيٌاكبت انؼصر ًانتمذو انؼهًِ‬ ‫‪.2‬تخرد كٌادر تًرّضْت راث كفبءة ػبنْت لبدرة ػهِ انتؼبيم يغ يتطهببث انًزتًغ‬ ‫ًيتغْراث نظبو انرػبّت انصحْت فَ يزبل انتًرّض‬ ‫‪.3‬تطبْك انًيبراث انتًرّضْت ًانسهٌكْت فَ تمذّى انؼنبّت انتًرّضْت ًحم انًشكالث انصحْت‬ ‫نهًرضَ‬ ‫‪.4‬تطبْك انًيبراث انؼهًْت ًانسهٌكْت فَ تمذّى انؼنبّت انتًرّضْت‬ ‫‪ً.5‬صف تأحْر انخمبفبث انًختهفت ػهَ انرػبّو انصحْو انًمذيو‬ ‫تمْْى انحبالث انسرّرّت انًختهفت ين خالل االستمصبء انؼهًَ ًانتحهْم انًنطمِ انًبنَ ػهَ‬ ‫انبراىْن‬ ‫‪5‬‬  [email protected] [email protected] [email protected] Tanta University Faculty of Nursing Medical Surgical Nursing Department Medical Surgical Nursing 1 ( T ) Course Specification 1- Course Information ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Course name:- Medical Surgical Nursing 1 (T) Course code:- NUR 231 Academic year:- 2024-2025 Teaching hours:- 2nd level- 3rd semester Theoretical 48 Cr Hr Course Aim At the end of this course the students will be able to a quire knowledge, skill and competency to apply nursing care modalities on clients with respiratory, cardiovascular, gastrointestinal disorders, cancer, burn and organ transplantation cases using nursing process based on critical thinking 2024/2025 2024/2025 2024/2025 technique, evidence-based nursing and the principles of rehabilitation. Use predictable medical-surgical problems of the adult patient. Cultural and psychosocial influences are considered in the care of diverse patient populations. 2-Course competences Program competences Course competences Domain 1: Professional and ethical practice Competence 1. 1: Demonstrate knowledge, understanding, responsibility and accountability of the application of nursing practice. 1.1.1 Identify normal structures and functions of the body systems 1.1.2 Outline the pathophysiology of common health problems and the relevant diagnostic procedures 6  [email protected] [email protected] [email protected] 1.1.3 Differentiate possible signs and symptoms that a patient may experience related to the improper function of the cardiac, pulmonary, and GIT systems 1.1.4 Differentiate normal/abnormal diagnostic tests, physiological assessments, psychological tests and health histories to specific nursing and ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ medical diagnoses for adult and older adult patients in diverse settings by using a variety of skills. 1.1.5 Enumerate the therapeutic medical, surgical and nursing modalities for clients with disorders of these body systems based on underlying scientific and behavioral principles 1.1.3.3 Employ a therapeutic nurse- patient/client 2024/2025 2024/2025 relationship based on mutual respect and 2024/2025 caring. Domain 2: Holistic patients/clients care Competence 2.1: Provide holistic and evidence-based nursing care in different practice settings. 2.1.1 Collaborate in achieving effective team work practices through acquired knowledge and appropriate communication skills 2.1.2 Implement teaching plans for patients and their families with common health problems and well defined health learning needs while coordinating human, information and material resources in a cost effective manner. 2.1.3 Use clinical reasoning, the nursing process, and 7  [email protected] [email protected] [email protected] established evidence-based policies as the basis for decision making in nursing practice. 2.1.4 Exhibit respect and responsibility through adherence to the code professional standards of ethical healthcare 2.1.1.2 Evaluate body system functions in health and illness ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 2.1.1.3 Consider normal body system structure during assessment process. 2.1.2.4 Demonstrate the ability to determine the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based on interpretation of health-related data.. 2.1.3.1 Apply holistic patients/clients care respecting individuals and families diversity. Domain 2: Holistic patients/clients care 2024/2025 2024/2025 2024/2025 Competence 2.2 Provide health education based on the needs/problems of the patient/client within a nursing framework. 2.2.1 Assess health related learning needs of patients/clients within the context of their cultures, values and norms. 2.2.2 Evaluate factors that influence patients/clients learning abilities such as readiness to learn, learning style and level of health literacy. 2.2.3 Apply educational principles and counseling techniques effectively in different health care settings with diverse populations. 2.2.4 Communicate health information and coordinate health education/promotion activities effectively to 8  [email protected] [email protected] [email protected] meet the patients/clients' needs. 2.2.5 Use variety and reliable information resources for planning and improving health promotion and educational activities. Domain 3: Managing people ,work environment and quality Competence 3.1: Demonstrate effective managerial and leadership skills in the ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ provision of quality nursing care. 3.1.1 Apply principles of safe, evidence-based and ethical nursing care for physical, psychosocial and rehabilitation approaches to health disorders 3.1.2 Provide high quality comprehensive nursing care employing the nursing process with critical thinking and attentiveness 3.1.3 Differentiate among the roles/functions of interdisciplinary health team members in the chronic 2024/2025 2024/2025 2024/2025 care setting. 3.1.2.1 Design change plan to enhance improvement of health care provision. 3.1.2.2 Accept and make assignments that take into consideration patient safety and organizational policy. 3.1.3.1 Document nursing activities in timely and thorough manner. Domain 3: Managing people ,work environment and quality Competence 3.2 :Provide a safe working environment that prevents harm for patients and workers 3.2.1.1 Utilize skills to recognize and assess risks and harms in work environment 3.2.1.2 Manage effectively identified health risks to 9  [email protected] [email protected] [email protected] provide safe care that best meets the needs and interests of individuals, families and communities. 3.2.2 Demonstrate knowledge of the Texas Nursing Practice Act and the Texas Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards, and comply with all ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ mandatory reporting requirements. Domain 3: Managing people ,work environment and quality Competence 3.3: Review health care outcomes in the light of quality indicators and benchmarks to achieve the ultimate goals of improving the quality of nursing care. 3.3.1 Apply quality improvement process to enhance nursing care to achieve optimal patients/clients desired outcomes. 3.3.2 Provide nursing care based on standardized protocols to improve quality of care and promote 2024/2025 patients safety.2024/2025 2024/2025 3.3.3 Provide nursing care based on standardized protocols to improve quality of care and promote patients safety. Domain 4: Informatics and technology Competence 4.1: Utilize information and technology to underpin health care delivery, communicate, manage knowledge and support decision making for patient care. 4.1.1 Utilize different sources of data related to advanced standards of practice and patient care. 4.1.2 Implement technology and information management tools to support safe care and evaluate their impact on patient outcomes. 4.1.3 Evaluate the effect of using information 11  [email protected] [email protected] [email protected] technologies on providing optimal nursing care. 4.1.4.1 Integrate information management technologies for providing the holistic patient care in different health care settings. Domain 4: Informatics and technology Competence 4.2 : Utilize information and communication technologies in the ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ delivery of patient/client care 4.2.1 Communicate and collaborate with patients, their families, and the interdisciplinary health care team in a timely manner to assist in the planning, delivery, and coordination of patient centered care to assigned patients in a way that promotes optimal health. 4.2.2 Integrate communication technologies that support clinical decision making, care coordination, and 2024/2025 protect patients' rights. 2024/2025 2024/2025 Domain 5: Inter-professional communication Competence 5.1 Collaborate with colleagues and members of the health care team to facilitate and coordinate care provided for individuals, families and communities. 5.1.1 Collaborate with different disciplines in a variety of settings to maximize health outcomes for the patients, families and communities 5.1.2 Maintain behavioral norms related to interdisciplinary communication and health care organizations when providing functional roles. 11  [email protected] [email protected] [email protected] ‫عذد‬ ٍ‫انجذول انضين‬ ‫انًىضــــــــــــــــــــىع‬ -4 Unit ‫و‬ ‫يحرىي‬ ‫(انساعاخ‬cr) First term ‫انًقشس‬ Nursing process (T) 6 1st ,2nd week I 1 Cardiovascular disorders & II 3rd,4th, 5th ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 9 management. (T) 2 week III 6 th,7th 8th Respiratory system disorder 9 3 week management. (T) Gastrointestinal disorder IV th th 6 9 10 week management. (T) 4 Cancer. (T) 6 11th 12th week V 5 Burn &reconstructive th th 6 13 14 week surgery management (T) VI 6 2024/2025 2024/2025 2024/2025 organ transplantation (T) 6 week15 th, 16th VII 7 48 cr hr 16 weeks Total  Lectures ‫ أسانُة‬-5 ‫انرعهُى‬  Case studies :‫وانرعهى‬  E- learning  Field trips ‫ أسانُة انرعهُى وانرعهى نهطالب روٌ انقذساخ‬-6 :‫انًحذودج‬ :‫ ذقىَى انطالب‬-7.1. Written Examination -‫ا‬.2. semester work ‫انطشق‬ ‫انًسرخذيح‬ ً‫ف‬ :‫انرقىَى‬ 12  [email protected] [email protected] [email protected] -‫ب‬ Assessment Week ‫انرىقُد‬ Final written At the end of each semester :‫نكم ينها‬ Exam (3 hrs) Semester Throughout each semester work Mark weight -‫ج‬ Semester ‫ذىصَع‬ Items of assessment Weight marks :‫انذسجاخ‬ Semester work 30 30% ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Final term written examination 70 70% Total for each semester 100 100% :‫ قائًح انكرة انذساسُح وانًشاجع‬-8 -Course Book for Medical Surgical Nursing I 2023-2024 :‫ يزكشاخ‬-‫ا‬ -Farrell, M.J. Smeltzer & Bare's Textbook of Medical Surgical :‫ كرة يهضيح‬-‫ب‬ Nursing. Philadelphia, Lippincot, Williams & Wilkins; 2019. -Smeltez S.C., & Bare B.G.:Brunner & Suddarths:Text book of Medical-Surgical Nursing, 12 th ed., New York Lippincott Co.; 2019. 2024/2025 2024/2025 2024/2025 ‫ كرة يقرشحح‬-‫ج‬ -Timby B, and Smith N., Introductory medical surgical nursing. 9th ed. London. GB Lippincott Williams and Wilkins com; 2019 -Smith S ,Duell D and martin B. , clinical nursing skills: Basic to advanced skills. 7th ed. London. Pearson prentice Hall com; 2019 -Kaplow, R., & Hardin, S.R., Critical Care Nursing Synergy for Optimal Outcomes, Jones &Barttett Co., USA.; 2020 -Barran, V.A., Critical Care Nursing: Increadibly Easy, 2nd ed., Lippincott Co., USA.; 2019 -Bodzewich, S.H. &Molshek, D. , Lippincott Manual of Nursing Practice Series Assessment, 8th ed., Lippincott Co. USA; 2020 - Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb‘s Fundamentals of Nursing: concepts process and practice (10th ed.). 13  [email protected] [email protected] [email protected] Hoboken: Pearson. - www.medescape.com,www.google.com ,www.yahoo.com ‫ دوسَاخ عهًُح‬-‫د‬ ‫أو نششاخ‬ - www. American Association of nursing , www science daily -Patricil a M. Dillon,medical surgical A CRITsugicarICAL THINKING, CASE STUDIES APPROACH, 2nd ed., F. A. Davis Company Philadelphia, 2007. ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Head of Department : Prof. Dr./ Amany lotfy. course coordinator : prof. Dr seham Ahmed Teaching Staff :- Prof.Nagwa Ragab, Prof Dr. Afaf Bassal, Prof. Seham Ahmed, Prof. Monera Elsheemy, Assist. Prof. Amany Kamal. Dr. Mariam Elshafeay, Dr. Shymaa Khalil, Dr. Alyaa Wahied Date: 2024-2025 2024/2025 2024/2025 2024/2025 14  [email protected] [email protected] [email protected] Nursing process Learning Objectives: Up on completion of this topic, the student will be able to identify; -Definitions - The purpose of the nursing process -Advantages of Nursing Process ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ -Characteristics of nursing process -Component on nursing process: -assessment -nursing diagnosis -planning Implementation -evaluation Nursing process 2024/2025 2024/2025 2024/2025 It is defined as systematic method of planning that guides all nursing actions during patient-focused care. The nursing process requires nurse‘s critical thinking to provide best care possible to client. The purpose of the nursing process 1- Provide a systematic method for nurses to plan and implement care. 2- Provides framework for nursing care in all healthcare settings. 3-Provide care for clients that are individualized, effective, and efficient. 4-Identify client‘s health status, actual or potential healthcare problems. 5- Protect nurses against legal problems related to nursing care. Advantages of Nursing Process Create a health data base of a patient. Establish priorities of nursing actions. Define specific nursing actions for proper care to patients. Increase the effectiveness of nursing care. 15  [email protected] [email protected] [email protected] Characteristics of nursing process: 1. Based on knowledge: Effective use of nursing process requires nurse to utilize knowledge and skills to resolve problems. Nurses should continuously strengthen skills during interventions. 2- Client-centered: The nursing process is intended to manage patient and is in the best interest of the patient. Help to identify specific goals related to wellness promotion and illness prevention ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 3- Cyclic and Dynamic: – Data from each phase provides the input into the next phase so that is becomes a sequence of events (cycle) that are constantly changing (dynamic) base on client‘s health status. 4-Interpersonal and Collaborative: Explain amount of interaction that might be necessary between nurses, patients of similar illnesses and the medical team. 5-Universally applicable: It is like a common nursing language with common nursing terminology followed universally. This process is 2024/2025 universally standard and no matter2024/2025 what the institution it may2024/2025 be. Component of nursing process: Assessment Diagnosis. Planning. Implementation. Evaluation. 16  [email protected] [email protected] [email protected] I- Assessment : The first phase of nursing process. In this phase, the nurse collects and organizes data related to the patient. Data includes information about patient, caregivers, environment as it is relevant to health and well-being. Purpose of assessment: 1. Establish communication with patient. 2. Establish communication with patient's family or caregivers. ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 3. Conduct a patient interview, the patient interview is one of the main sources of information used to plan patient care. 4. Collect objective and subjective data; Types of data: 1- Objective data (signs): Objective data are measurable data collected via the senses, such as sight, touch, smell, or hearing, and compared to an accepted standard, as vital signs, height and weight, body temperature, pulse, and respiratory rates, blood pressure, vomiting, presence of edema, 2024/2025 2024/2025 2024/2025 lung sounds, crying, skin color. 2- Subjective data: are information perceived only by the patients and can't be perceived by another person. Subjective data are also called symptoms. Ex: nauseated or numbness, pruritus Types of assessment:- 1-Comprehensive assessment; Information which gathered on initial contact with the patient after admission to health care agency to assess all aspects of health status. 2-Focused assessment; data which gathered to determine status of a specific problem identified in an earlier assessment. 3- Emergency; it is used during any physiologic or psychological crises of the client to Identify life-threatening problems. 4-Ongoing assessment; is assessment that includes systematic monitoring and observation of specific problems, it occurs several months after initial. 17  [email protected] [email protected] [email protected] Sources of data: 1-Primary Source; Client is the main source of data. 2-Secondary Source ; Family members, physical examination, nursing history, team members, lab reports, diagnostic tests, information in current and past medical records. Skills are required for the Assessment Phase Nurses must demonstrate excellent verbal, written communication skills, ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Strong attention to detail. Possess an in-depth understanding of body systems. The most frequently used clinical skills for patient assessment are inspection, percussion, palpation, and auscultation. Methods of Data Collection: 1-Interview It is a planned conversation with the client to get information, identify problems, evaluate change, and provide support or counseling. It is used 2024/2025 while taking the nursing history of2024/2025 a client 2024/2025 2- Observation – used to gather data by using the 5 senses and instruments. 3-Examination It is systematic data collection to detect health problems by using unit of measurements, physical examination techniques by using the following methods: inspection, Palpation, auscultation and Percussion, and interpretation of laboratory results. II- Nursing diagnosis A nursing diagnosis is the 2nd step of nursing process, a statement that describes a client‘s actual or potential health problems that a nurse can order nursing interventions. 18  [email protected] [email protected] [email protected] Purpose:- 1. Identify and define Problems related to the medical diagnosis. 2. Identify Risk Factors: any problem that could result because of the patient‘s medical diagnosis is a risk factor for a nursing diagnosis. 3. Analyze Data; All data gathered during assessment phase of nursing process must be analyzed to support an appropriate nursing diagnosis. 4. Establish a nursing diagnosis: After identifying problems and risk ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ factors, analyzing data, the nurse can then establish a nursing diagnosis to establish a nursing care plan. Characteristics of Nursing Diagnosis: 1. It states a clear and concise health problem. 2. It is derived from existing evidences about the client. 3. It is the basis for planning and carrying out nursing care. Nursing diagnosis versus medical diagnosis: Nursing diagnosis: Describe client health problems that nurses can treat 2024/2025 2024/2025 2024/2025 independently. Medical diagnosis: Identify disease and describe problems for which the physician directs the primary treatment. NANDA diagnosis: The use of standard nursing diagnostic statements endorsed by the North American Nursing Diagnosis Association (NANDA) severs several purposes. Each diagnosis has precise definition that gives all members of the health team a common language for understanding the client's needs. Components of NANDA nursing diagnosis, 1-Problem or diagnostic label: the problem statement describes client's health problems. Its purpose is to direct the formation of client goal and desired outcomes. For example; impaired skin integrity. 19  [email protected] [email protected] [email protected] 2-Etiology or cause of the problem (related factor): it identifies one or more probable causes of health problems, gives direction to the required nursing care and. As bed wetting 3-Signs and symptoms of the problem (defining characteristics): are the cluster of signs and symptoms that indicate the presence of a particular diagnostic label, as redness Ex: constipation related to decreased activity and fluid as manifested by small, ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ hard, formed stool every four days Types of nursing diagnoses: 1-Actual: a client problem that is present at time of nursing assessment. It is based on the presence of signs and symptoms. Examples: Imbalanced Nutrition: Less than body requirements r/t decreased appetite nausea. 2-Potential nursing diagnosis: is incomplete or unclear problem requires more data to support it; but a problem is considered possible to occur. Examples: Possible nutritional deficit III-Planning 2024/2025 2024/2025 2024/2025 The planning phase is the stage where nursing care plans that outline goals and outcomes are created. The goals and outcomes formulated during this phase directly impact patient care. Purpose of a nursing care plan: 1. Provides direction for personalized patient care based on the client's needs. 2. Enhances communication between patients, nurses, and other team. 3. Encourages continuity of care Characteristics of a quality nursing care plan: 1- It focuses on actions which are designed to solve problem. 2- It relates to the future. 2- It is based upon identifiable health and nursing problems. 21  [email protected] [email protected] [email protected] Stages of planning; 1-Initial planning; is developed by the nurse, who performs admission nursing history and the physical assessment. 2-Ongoing planning; is carried by the nurse to keep the plan update, by analyzing data to make plan more accurate. 3-Discharge planning; is best carried out by the nurse, who has worked most closely with patient and family ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Guideline for writing goals 1-make sure that goal statement is appropriate for nursing diagnosis. 2- make sure that the outcome criteria are realistic. 3- Make sure that each goal is derived from only one nursing diagnosis IV-Implementing = intervening It is the fourth step in the nursing process; it is action performed by the nurse that helps the client achieves the results specified by the goals and expected outcomes. 2024/2025 2024/2025 2024/2025 Types of Nursing Interventions: 1. Independent nursing interventions: are initiated by the nurse and do not require direction or an order from another health care professional. 2.Interdependent nursing interventions: are implemented collaboratively by the nurse in conjunction with other health care professionals. 3. Dependent nursing interventions: require an order from a physician or another health care professional. Factors that affect implementation; A-Clients factors as; willingness to participate in the care, previous responses to nursing measures. B- Nurse factors as; level of experiences, willingness to provide care C- Resources as; adequate staff, equipment and supplies. 21  [email protected] [email protected] [email protected] V-Evaluation It is the fifth step in the nursing process, determines whether client goals have been met, partially met, or not met. When a goal is met, the nurse decides whether nursing interventions should stop or continue for the status to be maintained. When a goal is partially met or not met, nurse reassesses situation and modifications to the plan of care are determined by more data collection. ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Reasons that goals are not met or only partially met include: Initial assessment data were incomplete. Goals and expected outcomes were unrealistic. Time frame was not adequate Types of evaluation: - 1- Ongoing evaluation; is done while or immediately after implementation to enable nurse to make on spot modification in intervention. 2024/2025 2024/2025 2024/2025 2- intermittent; performed at specific intervals as once a week, shows the extent of progress toward goal achievement and enables the nurse to correct any deficiency and modify the care plan as needed. 3- terminal; indicates the client condition at the time of discharge; it includes the status of goals achievement and an evaluation of the client self-care abilities with regard to follow up care. 22  [email protected] [email protected] [email protected] Cardiovascular disorder ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 2024/2025 2024/2025 2024/2025 The circulatory system, also called the cardiovascular system is an organ system that permits blood to circulate and transport nutrients, oxygen, carbon dioxide, hormones, and blood cells to and from the cells in body to provide nourishment and fighting diseases The human heart is a hollow, four chambered, muscular pump. It is the major organ in the mediastinum. The pericardium is the outermost layer of the heart. The myocardium makes up the walls of the heart chambers. 23  [email protected] [email protected] [email protected] Cardiovascular abnormalities Coronary artery diseases and Coronary atherosclerosis Learning objectives At the end of this session the students should be able to; 1-identify definition of atherosclerosis ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 2- Causes and path physiology 3-symptoms 4-risk factors 5-medical treatment 6- Prevention Coronary artery diseases Coronary artery disease (CAD) is a narrowing or blockage of coronary 2024/2025 2024/2025 2024/2025 arteries, usually due to plaque buildup. Coronary arteries supply oxygen- rich blood to heart. Plaque buildup in these arteries limits how much blood can reach heart. 24  [email protected] [email protected] [email protected] Coronary atherosclerosis Atherosclerosis is the buildup of fats, cholesterol and other substances on artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque can leading to a blood clot. Causes The exact cause for atherosclerosis is unknown. It may start with damage ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ injury to the inner layer of an artery. The damage may be caused by:  High blood pressure  High cholesterol  High triglycerides, a type of fat (lipid) in the blood  Smoking  Diabetes  Insulin resistance  Obesity 2024/2025 2024/2025 2024/2025  Inflammation from an unknown cause or from diseases as arthritis. Pathophysiology:- 1- low-density lipoprotein molecules (LDL) becoming oxidized by oxygen free. When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL. 2--The body's immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL forming specialized foam cells. Unfortunately, these white blood cells are not able to process the oxidized-LDL, and ultimately grow then rupture 3-Eventually, the artery becomes inflamed. 25  [email protected] [email protected] [email protected] 4-The cholesterol plaque causes the muscle cells to enlarge and form a hard cover over the affected area. This hard cover causes a narrowing of the artery, reduces the blood flow and increases blood pressure. ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Physiologic factors that increase risk 1-Modifiable 2024/2025  Having diabetes 2024/2025 2024/2025  Tobacco smoking,  Having high blood pressure  Elevated serum C-reactive protein concentrations 2-Nonmodifiable  Advanced age  Male sex  Having close relatives who have had some complication of atherosclerosis (eg. coronary heart disease or stroke)  Genetic abnormalities 3-Lesser or uncertain  Being obese (in particular central obesity)  A sedentary lifestyle  Elevated serum levels of triglycerides 26  [email protected] [email protected] [email protected] Signs and Symptoms Signs and symptoms depend on degree of narrowing of arterial lumen, thrombus formation and obstruction of blood flow as following:-  inadequate supply of blood that leads to deprives in oxygen in muscle (ischemia)  Angina pectoris, chest pain that is brought about by myocardial ischemia, usually caused by coronary atherosclerosis ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬  if blood supply decrease is great and longer, myocardial infarction produce  Damaged myocardium replaced by scar tissue causing various degree of myocardium dysfunction.  -Inadequate cardiac output and heart failure occur Treatment Non-pharmaceutical are usually the first method of treatment, such as cessation of smoking and regular exercise. If these methods do not work, 2024/2025 2024/2025 2024/2025 medicines are usually the next step. 1-Statins; In general, the group of medications referred to as statins that has been widely prescribed for treating atherosclerosis. Example; lovastatin (20-80mg), simvastatin (zocar 20-80 mg) and fluvastatin (lescol 20-80 mg) Its action; block cholesterol synthesis, lower low density lipoprotein and triglyceride levels and increase high density lipoprotein (HDL). 2-Nicotinic acids: As niacin ( niaspan) it decrease lipoprotein synthesis, lower low density lipoprotein and triglyceride levels and increase high density lipoprotein. it is used for minimal elevated cholesterol and low density lipoprotein levels. 3-Fibric acid or fibrates ( atromid). It used to lower low triglyceride levels and increase high density lipoprotein. It is indicated for patients with triglyceride levels above 400 mg/dl. 27  [email protected] [email protected] [email protected] 4-Bil acid resins (cholestyramine) it binds with cholesterol in intestine increase its breakdown and lower low density lipoprotein, no effect on triglyceride. It is used for patients with triglyceride level less than 200 mg. Prevention:- 1-controlling cholesterol abnormalities; -Four elements of fat metabolism (total cholesterol (N R less than 200 ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ mg/dl) , low density lipoprotein ( NR less than 130 mg/dl) , high density lipoprotein ( NR 35-65 mg/dl) and triglycerides ( NR 40-150 mg/dl) must be controlled. -Lipids should be checked every 6 weeks until desired level obtained and then every 4-6 months. -LDL exerts harmful effect on arterial wall and lead to atherosclerosis; in contrast HDL promotes use of total cholesterol by transporting LDL to liver where it excreted. 2024/2025 2024/2025 2024/2025 -HDL should exceed 40 mg/dl and should be ideally more than 60 mg/dl, HDL is protective for patient. - Elevated triglyceride more than 200 mg/dl may be genetic and caused by obesity, physical inactivity, high carbohydrate diet, and DM and kidney disease. 2-Dietary measures:- -Vitamin C acts as an antioxidant in vessels and inhibits inflammatory process. It has therapeutic properties on high blood pressure and arterial stiffness in diabetes. Vitamin C is also a natural regulator of cholesterol and higher doses (over 150 mg/kg daily). -total fat must be 25-35% of total calorie, CHO must be 50-60%, fiber must be 20-30 g/day, protein must be 15% and cholesterol less than 200mg/day 28  [email protected] [email protected] [email protected] - Dietary fiber help in lower cholesterol levels, which found in fresh fruits, vegetables, enhance excretion of metabolized cholesterol. 3-physical activity:- -Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight. Having a healthy weight reduces chances of developing high blood pressure. -instruct patient to stop any activity if feel with chest pain, unusual ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ shortness of breath, dizziness or nausea. 4-promoting cessation of tobacco use:- - Smoking constricts blood vessels, forcing heart to work even harder to pump blood. Quitting smoking is one of the best ways to lower risk of coronary artery disease and improve overall health. - A smoking cessation program can help successfully quit smoking – and start experiencing health benefits the same day you quit. 5-managing hypertension:- 2024/2025 2024/2025 -hypertension is blood pressure measurement exceed 140/90 2024/2025 mm/hg, long standing elevated blood pressure result in stiffness of vessel wall leading to vessel injury and inflammatory response within intimae. - It also increases work of left ventricle which pumps harder to eject blood into arteries. Increase workload causes heart to enlarge and thicken which lead to cardiac failure. 29  [email protected] [email protected] [email protected] Angina pectoris Learning objectives; At the of this session the students should be able to identify 1-defintion of angina 2-subtypes of angina 3-risk factors ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 4-pathophysiology 5-symptoms and diagnosis 6-medical treatment 7-nursing process for patient with angina Angina pectoris is severe chest pain due to ischemia (a lack of blood and oxygen supply) of the heart muscle, due to obstruction of the coronary arteries. Subtypes of angina 2024/2025 2024/2025 2024/2025 1-Stable angina; this refers to angina related to myocardial ischemia. Typical presentations of stable angina are that of chest discomfort and develops when heart works harder in case of exercise with minimal symptoms at rest. Lasts a short time, perhaps five minutes or less. 2-Unstable angina (medical emergency); is defined as angina pectoris that changes or worsens.It has at least one of these three features: 1. it occurs at rest (or with minimal exertion). 2. it is severe 3. It occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previously). 3-variant angina; It is occurring often at night (unrelated to activity), it is caused by coronary artery spasm with or without atherosclerotic lesions. It may often severe and may be relieved by angina medication. 4-Silent ischemia; It may occur with either activity or with mental stress. 31  [email protected] [email protected] [email protected] Risk factors associated with angina pain:- 1-physical exertion which start attack by increase oxygen demand. 2-exposure to cold which cause vasoconstriction and increase blood pressure with increase oxygen demand 3-eating heavy meals which increase blood flow to mesenteric area for digestion and decrease blood supply to heart muscle 4-stress causing increase blood pressure and increase myocardium ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ workload. 5- Obesity raises risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure Pathophysiology Increase in heart rate results in increased oxygen demand by the heart. The heart has a limited ability to increase its oxygen intake during episodes of increased demand. Myocardial ischemia can result from: 1. a reduction of blood flow to the heart that can be caused by 2024/2025 stenosis, or acute occlusion 2024/2025 2024/2025 (by an embolus) of the heart's arteries 2. resistance of the blood vessels 3. Reduced oxygen-carrying capacity of the blood. Atherosclerosis is the most common cause of stenosis (narrowing of the blood vessels) of the heart's arteries and, hence, angina pectoris. Myocardial ischemia also can be the result of factors affecting blood composition, such as reduced oxygen-carrying capacity of blood, as seen with severe anemia (low number of red blood cells), or long-term smoking. Symptoms -Chest discomfort is usually described as a pressure, heaviness, tightness, and squeezing, burning, or choking sensation. Anginal pains radiated in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders. This is explained by the concept of referred pain, Typical locations for 31  [email protected] [email protected] [email protected] referred pain are arms (often inner left arm), shoulders, and neck into the jaw. -Pain may be accompanied by breathlessness, sweating and nausea in some cases. It usually lasts for about 3 to 5 minutes. -Myocardial ischemia comes about when the myocardium (the heart muscles) receives insufficient blood and oxygen to function normally - "autonomic symptoms" (related to increased activity of the autonomic ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ nervous system) such as nausea, vomiting and pallor. -Weakness, numbness in arm, wrist and hands may accompany pain Diagnosis 1- Electrocardiogram (ECG); during periods of pain, depression or elevation of the ST segment and T wave may be flatten or invert. 2-Exercise ECG test; may be performed, during which the patient exercises to their maximum ability before fatigue, breathlessness or pain, if characteristic ECG changes are documented (typically more than 1 mm 2024/2025 2024/2025 2024/2025 of flat or down sloping ST depression). 3-a coronary angiogram; performed to identify the nature of the coronary lesion, indicated for angioplasty, coronary artery bypass graft. 4-Echocardiography; is non-invasive procedure that uses ultrasound to evaluate cardiac structure and function, it may be done at rest, during supine exercises 4-C- reactive protein is indicated due to coronary artery disease is result from inflammation of arterial endothelium Medical management:- Goal of management are decrease demand of myocardium and increase oxygen supply. It is achieved by pharmacologic therapy and control of risk factor 32  [email protected] [email protected] [email protected] 1-pharmacological therapy includes the following; A-Nitroglycerine; (nitropaste, nitro-Dur, nitro-Bid), isosorbide dinitrate ( isordil) , it is given sublingual, by spray or intravenously for immediate effect or orally. Sublingual nitroglycerine acts within 1-2 minutes, decrease myocardial work and oxygen demand through dilate veins, reduce venous return, cardiac work and dilate artery with higher dose which reduces vascular resistance. It helps increase coronary blood flow ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ by preventing vasospasm. b-Beta- adrenergic blocking agents; as tenormin, metoprolol (lopressor), propranolol (inderal). It reduce myocardial oxygen consumption which lead to decrease heart rate, decrease blood pressure and reduce myocardial contractility that provide balance between myocardial needs and supply of oxygen this help in control chest pain. C- Calcium channel blocking agents; as ( procardial, cardizem, isoptin, vascor). It is used to control angina, hypertension by slow heart rate. It is 2024/2025 2024/2025 also relax blood vessels causing decrease in blood pressure.2024/2025 It increases myocardial oxygen supply by dilating smooth muscle wall of coronary arteriole. d- Antiplatelet drugs; given to prevent platelet aggregation which impedes blood flow. It includes the following medications 1-Aspirin and clopidogrel (plavix); they are prevent platelet activation in arteries, preventing development of arterial thrombus. The dose of aspirin is given is 80-325 mg/day. Clopedogrel is given to patient who is allergic to aspirin. 2-intravenous antiplatelet drugs; as (reopro, integrelin) it block final common pathway of platelet activation but the risk of bleeding is greater than with orally administered antiplatelet drugs. 33  [email protected] [email protected] [email protected] E-Heparin (anticoagulant drugs); prevent formation of new blood clots ,reduce occurrence of myocardium infarction, if patient is hospitalized he given heparin every 4-6 hours. 2- Oxygen administration- usually initiated at onset of chest pain to increase amount of oxygen delivered to myocardium and decrease pain. Prevention 1-Quitting smoking ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 2-Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes 3-Eating a healthy diet and maintaining a healthy weight 4-Increasing physical activity for 150 minutes of moderate activity each week. Plus 10 minutes of strength training twice a week and to stretch three times a week for 5 to 10 minutes each time. 5-Reducing your stress level 6-Limit alcohol consumption to two drinks or fewer a days for men, and 2024/2025 one drink a day or less for women.2024/2025 2024/2025 7-Get an annual flu shot to avoid heart complications from the virus Nursing process for patients with angina pectoris Assessment:- -health history as chest pain, including type, intensity, duration, aggravating factors and relief measures; associated symptoms -history of other cardiovascular disorder, stroke, current medications and unusual diet, exercise and alcohol intake, smoking history. -physical assessment; vital signs and heart sounds, strength and e of peripheral pulse equality of peripheral pulses, skin color and temperature (central and peripheral), physical appearance during pain episode (e.g., shortness of breath, apparent anxiety, color). 34  [email protected] [email protected] [email protected] Nursing diagnosis and interventions:- 1-Ineffective myocardial tissue perfusion secondary to coronary artery disease as manifested by chest pain Goal; improve tissue perfusion, decrease chest pain. Nursing care; - nurse should direct patient to stop all activities and sit or rest in bed in semi –fowler position to reduce oxygen requirement. ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ -nurses assess patients angina and continuous this assessment for patients. -measure vital signs and observe signs of respiratory distress - Keep prescribed nitroglycerine tablets at the patient's side. -Start oxygen to reduce myocardial hypoxia and smoking cessation. -space activities to allow rest between them, activity increase cardiac work and may precipitate angina. -teach about prescribed medications to maintain myocardial perfusion and reduce cardiac work. 2024/2025 2-Anxiety related to fear of death2024/2025 2024/2025 Goal; reducing anxiety Nursing care; -. -providing information about illness, treatment and method of preventing its progression is very necessary to decrease anxiety. -various stress reduction methods should explore with patient as music therapy, relaxation technique. -give patients opportunity to express feeling and ask any question 3-Pain related to decrease oxygen supply to myocardium muscle Goal; preventing or reducing pain Nursing care; -the nurse assess patients pain and if activity increase patients pain, plan activities according to ability of the patients. -balance between rest and activity and rest is very important aspect of educational plan for patients and family. 35  [email protected] [email protected] [email protected] -Keep prescribed nitroglycerine tablets at the patient's side so one can be taken at the onset of pain. 4- Deficient knowledge about underlying disease and method of prevent complication Goal; improve patient's knowledge Nursing care; - assess knowledge and understanding of angina. Assessment allows tailoring of teaching and interventions to the needs of ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ the patients. -learning about risk factors that increase development of coronary artery disease and result in angina. -provide written and verbal instructions about prescribed medications and their use. It reinforces teaching and is available to the patient for future reference. -stress the importance of taking chest pain seriously while maintaining a positive attitude. 2024/2025 2024/2025 2024/2025 36  [email protected] [email protected] [email protected] Myocardial infarction (heart attack) Learning objectives At the end of this session the students should be able to identify 1-definition of myocardium infarction, causes and risk factors 2-pathophysiology, signs and symptoms 3-diagnosis, complication 4-medical treatment, surgical management ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ 5-cardiac rehabilitation 6- Nursing process for patient with myocardium infarction 2024/2025 2024/2025 2024/2025 Myocardial infarction commonly known as a (heart attack); it is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia). Causes 1-psychological stress or physical exertion, especially if the exertion is more intense than the individual usually performs. 2-Acute severe infection, such as pneumonia, can trigger myocardial infarction. 3-Trauma: This includes tears or ruptures in the coronary arteries. 37  [email protected] [email protected] [email protected] 4- Coronary artery spasm. Risk factors  Tobacco smoking  High blood pressure  Family history of ischemic heart disease (IHD)  Obesity  age Men acquire an independent risk factor at age 45, ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Women acquire an independent risk factor at age 55  prolonged intake to high quantities of alcohol Pathophysiology -A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, occluding the artery and preventing blood flow downstream. -Ruptures leads to a clotting cascade, sometimes resulting in total occlusion of the artery. Plaques can become unstable, rupture, and 2024/2025 2024/2025 2024/2025 additionally promote a thrombus (blood clot) that occludes the artery; this can occur in minutes. When a severe enough plaque rupture occurs in the coronary vasculature, it leads to myocardial infarction -cellular injury occur when cells are denied adequate oxygen and nutrients, when ischemia lasting more than 20 -45 minutes hypoxemic damage causes cellular death and tissue necrosis. - When large artery is compromised, collateral vessels connecting smaller arteries in coronary system dilate to maintain blood flow to the cardiac muscle; good collateral circulation can limit the size of MI. Signs and Symptoms  Chest pain; this can be mild and feel like discomfort or heaviness, or it can be severe and feel like crushing pain. It may start in chest and radiate to other areas like left arm, shoulder, neck, jaw, back or down toward waist. 38  [email protected] [email protected] [email protected]  Shortness of breath or trouble breathing.  Fatigue.  Trouble sleeping.  Nausea or stomach discomfort, heartburn.  Heart palpitations.  Anxiety  Sweating. ‫ﻣﺼﻄﻔﻰ ﺭﻣﻀﺎﻥ ﻣﺤﻤﺪ ﻣﺤﻤﺪ ﺧﻄﺎﺏ‬ Diagnosis - Electrocardiogram; the primary purpose of the electrocardiogram is to detect ischemia or acute coronary injury. Because unstable ischemic syndromes have rapidly changing supply versus demand characteristics, a single ECG may not accurately represent the entire picture. Angiography; A catheter is inserted into an artery (usually the femoral artery) and pushed to the vessels supplying the heart. A radio-opaque dye is administered through the catheter and a sequence of x-rays 2024/2025 2024/2025 2024/2025 (fluoroscopy) is performed. -A coronary angiogram allows visualization of narrowing or obstructions on the heart vessels and therapeutic measures can follow immediately. -An echocardiogram to help identify areas of heart that aren‘t working properly -A stress test to see how your heart responds to certain situations, such as exercise Laboratory tests:- Serum Cardiac markers (enzymes):- 1-The cardiac troponins T and I. Elevated troponins in the setting of chest