NCM118 (M) 2024-2025 Preliminary Notes - PDF

CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS, ACUTELY ILL NCM118 MULTI-ORGAN PROBLEMS , HIGH ACUITY AND EMERGENCY SITUATIONS 1st Semester | A.Y....

CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS, ACUTELY ILL NCM118 MULTI-ORGAN PROBLEMS , HIGH ACUITY AND EMERGENCY SITUATIONS 1st Semester | A.Y. 2024-2025 | PRELIM NOTES | jjardio What are the signs and symptoms of asthma? BRONCHIAL ASTHMA People with asthma usually have obvious Asthma is a chronic inflammatory disease symptoms. These signs and symptoms resemble of the airways which develops under the many respiratory infections: allergens influence, associates with Chest tightness, pain or pressure. bronchial hyperresponsiveness and Coughing (especially at night). reversible obstruction and manifests with Shortness of breath. attacks of dyspnea, breathlessness, cough, Wheezing. wheezing, chest tightness and sibilant rales more expressed at breathing-out. Clinical Classification of Asthma Bronchial asthma (or asthma) is a lung disease. Your airways get narrow and swollen and are blocked by excess mucus. Medications can treat these symptoms. ETIOLOGY As asthma is a respiratory allergic disease, the influence of allergens permeated into the organism through airways is essential for the disease development. The allergens are divided into: ○ Communal ○ Industrial ○ Occupational ○ Natural ○ Pharmacological Communal allergens are contained in the air of apartment houses. They are: house-dust mites which live in carpets, mattresses and upholstered furniture. spittle, excrements, desquamated epidermis, hair and fur of domestic animals. vital products of domestic insects (e.g., cockroach) mycelial yeast-like fungi (molds) tobacco smoke during active or passive smoking various communal aerosols and synthetic detergents. Occupational exposures: exposure to certain dusts (industrial or wood dusts), chemical fumes and vapors and Steps in testing and diagnosis molds. Medical history Physical exam Pharmacological: Spirometry Antibiotics, vaccines, and serums Exhaled nitric oxide test PATHOPHYSIOLOGY Additional Tests: X-ray or computerized tomography (CT) imaging of your chest. CT scans of your sinuses Blood tests. Gastroesophageal reflux assessment. Testing of the phlegm in your lungs for signs of a viral or bacterial infection. 1  covid 19, can cause viral pneumonia. 4. 4. Fungal Pneumonia a. fungal pneumonia is less common and typically affects individuals with weakened immune systems. 5. Aspiration Pneumonia a. this type of pneumonia occurs when foreign substances such as food, stomach acid, saliva, enter the lungs. Classification based on Location Lobar Pneumonia ○ Affects one or more lobes of a lung. It often presents with distinct consolidation of lung tissue in a specific area, resulting in symptoms ASTHMA COMPLICATIONS like high fever, chest pain and The complications of asthma exacerbations are: productive cough. pneumothorax Bronchopneumonia lung atelectasis ○ Is characterized by the inflammation pneumonia and infection of small airways and acute or subacute cor pulmonale bronchioles, rather than whole lobes. asthmatic status It often appears as patchy infiltrates on a chest X-ray and may result Persistent asthma causes: from various causative agents. fibrosing bronchitis small bronchi deformation and obliteration COMMUNITY-ACQUIRED VS. emphysema HOSPITAL-ACQUIRED PNEUMONIA pneumosclerosis Community-Acquired Pneumonia (CAP) chronic respiratory failure ○ Is contracted in non-healthcare chronic cor pulmonale settings, such as the community, at home, or in public places. Asthma in CHILDHOOD leads to growth inhibition Hospital-Acquired Pneumonia (HAP) and thoracic deformation. ○ Is acquired during a hospital stay within a healthcare facility. Life-threatening under certain circumstances Ventilator-associated Pneumonia (VAP) Severe airway obstruction ○ Subtype of HAP, patient has been Respiratory failure endotracheally intubated and has Silent asthma received mechanical ventilatory for Status asthmaticus at least 48 hours. Asthma-related complications Triggers and individual variability ATYPICAL VS. TYPICAL PNEUMONIA Medication non-compliance Typical Pneumonia Lack of access to healthcare ○ Is characterized by the classic symptoms of high fever, productive cough and pleuritic chest pain. PNEUMONIA Atypical Pneumonia Pneumonia is a form of acute respiratory ○ Caused by atypical pathogens like infection that is most commonly caused by Mycoplasma pneumoniae and viruses or bacteria. It can cause mild to Chlamydophila pneumoniae, often life-threatening illness in people of all ages, presents with milder symptoms such however it is the single largest infectious as a dry cough and low-grade fever. cause of death in children worldwide It may require different antibiotics or (WHO). antiviral medications. Types and Classifications OTHER TYPES OF PNEUMONIA 1. Atypical Pneumonia Necrotizing Pneumonia 2. Bacterial Pneumonia ○ Is a severe form with lung tissue a. this type of pneumonia is primarily destruction. caused by bacteria, with Persistent Pneumonia streptococcus pneumoniae being the ○ Doesn’t resolve as expected and most common culprit. may need further investigation 3. Viral Pneumonia through tests like bronchoscopy or a. viruses, including the influenza virus, lung biopsy to identify underlying respiratory syncytial virus (RSV), issues, with treatment tailored and the coronavirus responsible for accordingly. 2  Usual Interstitial Pneumonia Physical exam ○ Is treated with medications like ○ During a physical exam, the doctor corticosteroids or will listen to the lungs of the patient immunosuppressive drugs to using a stethoscope. manage inflammation and, in sever Sputum test cases, lung transplantation may be ○ If the patient is coughing up mucus considered. (phlegm), the doctor might ask to collect a sample of it. PATHOPHYSIOLOGY OF PNEUMONIA Blood tests ○ While blood tests can’t diagnose pneumonia on their own,t hese tests can help the doctor determine if there is an infection and what kind of infection it is. Pleural fluid test ○ In some cases, the doctor might need to do a pleural fluid test. Bronchoscopy ○ Often use for patients with acute severe infection, compromised immune system, and with chronic or refractory infection. TREATMENT OF PNEUMONIA Vaccination Medication Cover Your Mouth Stage of Congestion: Have Proper Rest ○ Vascular engorgement Healthy Foods ○ Engorgement of alveolar spaces with fluid and hemorrhagic exudates COMPLICATIONS which causes spread of pathogens ➔ Empyema: Infection of the space between through the lobe. the membranes surrounding the lungs and Stage of Red Hepatization: chest cavity. ○ Coagulation of the red exudates ➔ Pericarditis: Inflammation of the sac occurs and the affected lung surrounding the heart. appears red. ➔ Endobronchial obstruction: Blockage of Stage of Grey Hepatization: the airway that allows air into the lungs. ○ The decrease in RBC count is ➔ Atelectasis: Collapse of an entire lung or replaced by neutrophils which an area within the lungs. infiltrates the alveoli making the lung ➔ Lung abscess: Collection of pus in the tissue solid and grayish in color. lungs. ➔ Pleurisy: Inflammation of the thin CLINICAL MANIFESTATIONS membranes between the lungs and ribcage. Shaking chills ➔ Septicemia: Infection in the blood that Rapidly rising fever (39.5 to 40.5 degree) originated elsewhere in the body. Stabbing chest pain aggravated by ➔ Sepsis: A life-threatening immune reaction respiration and coughing. to septicemia. Tachypnea, nasal flaring ➔ Worsened chronic conditions: Patient is very ill and lies on the affected Pneumonia can exacerbate conditions like side to decrease pain congestive heart failure and emphysema. Use of accessory muscles of respiration e.g. ➔ Death: In severe cases, pneumonia can be abdomen and intercostals muscles fatal, especially in vulnerable populations Cough with purulent, blood tinged, rusty like young children and older adults. sputum Shortness of breath NURSING MANAGEMENT Flushed cheeks Promoting Respiratory Health Loss of appetite, low energy and fatigue Supporting Rest and Recovery Cyanosed lips and nail beds Ensuring Proper Nutrition Education and Support DIAGNOSTIC PROCEDURE Chest X-ray ATELECTASIS ○ This is a quick and painless imaging test that healthcare professionals Atelectasis is derived from the Greek words utilize to determine if there’s fluid or “ateles” and “ektasus”, meaning incomplete pus in the lungs, which is a sign of expansion. pneumonia. Refers to closure or collapse of alveoli. 3  Atelectasis and other conditions may also ❖ Chronic be called “collapsed lung”. Atelectasis In COPD patient (insidious and means that lung sacs cannot inflate slower in onset). In chronic properly, which means your blood may not atelectasis, the affected area is often be able to deliver oxygen to organs and characterized by infection, tissues. bronchiectasis, destruction, and scarring (fibrosis). DIAGNOSIS CT scan Based on Characteristics: Oximetry ❖ Compression Atelectasis Ultrasound of the thorax Occurs from the lesion of the thorax Bronchoscopy compresses the lungs. Is secondary to increased pressure RISK FACTORS exerted on the lung causing the Age - being younger than 5 or older than 60 alveoli to collapse. In other words, years of age. there is a “decrease” transmural Any condition that interferes with pressure gradient (transmural spontaneous coughing, yawning and pressure gradient =alveolar pressure sighing. - intrapleural pressure) across the Lung disease, such as asthma in children, alveolus resulting in alveolar COPD, bronchiectasis or cystic fibrosis. collapse. Premature birth Recent general anesthesia ❖ Cicatrization Atelectasis Respiratory muscle weakness, due to It results from the severe scarring of muscular dystrophy, spinal cord injury or the lung parenchyma and caused by another neuromuscular condition. the necrotizing pneumonia. Any cause of shallow breathing. Obesity ❖ Absorption Atelectasis Smoking Refers to the condition where the reduction of nitrogen concentration TYPES OF ATELECTASIS in the lungs causes a collapse. 1. Obstructive Atelectasis Most common type ❖ Adhesive Atelectasis Due to a physical blockage of airflow Results from surfactant deficiency. Obstruction can occur at the level of the This is observed particularly in acute larger or smaller bronchus respiratory distress syndrome (ARDS). Causes: ❖ Relaxation/Passive Atelectasis Mucus plug Results when pleural effusion or Foreign body-Atelectasis is common in pneumothorax eliminates contact children who have inhaled an object, such between parietal pleura and visceral as peanut or small toy part, into their lungs. pleura. Tumor in a major airway-an abnormal ❖ Rounded Atelectasis growth can narrow the airway. Occurs as consequence of distress Blood clot with chronic pleural scarring, especially asbestos-related pleural 2. Non Obstructive Atelectasis disease and TB. When alveoli collapse due to factors acting via other mechanisms. SIGNS AND SYMPTOMS Least common. Trouble breathing (shortness of breath) Causes: Increased heart rate Injury-chest trauma from a fall or car Coughing accident. Chest pain Pleural effusion Skin and lips turning blue Other conditions Pneumonia - different types of including asthma and emphysema can also pneumonia, an infection of your cause chest pain and trouble breathing. lungs, may temporarily cause atelectasis. CAUSES OF ATELECTASIS Pneumothorax Mucus plug Tumor - a large tumor can press Inhaled object against and deflate the lung. Fluid around the lungs (pleural effusion) Air around the lungs (pneumothorax) CLASSIFICATION OF ATELECTASIS Non-cancerous (benign) growths ❖ Acute Cancerous tumors Post operative settings, the lung has Lung scarring recently collapsed and is primarily Underlying illness notable only for airlessness. 4 TREATMENT Provide suctioning as needed for patients Chest Physiotherapy who are intubated or unable to clear their ○ Techniques that help you breathe own secretions. deeply after surgery to re-expand Administer sedatives with care because collapsed lung tissue are very these medications depress respirations and important. These techniques are cough reflex. learned before surgery. They Offer ample reassurance and emotional include: support because the patients limited Performing deep breathing breathing capacity may frighten him. exercises (incentive Assess breath sounds and respiratory spirometry) and using a status frequently. Report any changes device to assist with deep immediately. coughing may help remove Evaluate the patient’s ability to perform secretions and increase lung bronchial hygiene. volume. Monitor pulse oximetry readings and ABG Positioning your body so that values for evidence of hypoxia. your head is lower than your Demonstrate comfort measures to promote chest (postural drainage). relaxation and conserve energy. This allows mucus to drain better from the bottom of your lungs. CORONARY ARTERY DISEASE (CAD) Tapping on your chest over Is the narrowing or blockage of the coronary the collapsed area to loosen arteries, usually caused by atherosclerosis. mucus. This technique is Atherosclerosis (the hardening or clogging called percussion. You can of the arteries) is the build-up of the also use mechanical cholesterol and fatty deposits (plaques) on mucus-clearance devices, the inner walls of the arteries. These such as an air-pulse vibrator plaques can restrict the blood flow to the vest or a hand-held heart muscle by physically clogging the instrument. artery or by causing abnormal artery tone Surgery function. This can also lead to chest pain or ○ Removal of airway obstruction may angina, or a heart attack. be done by suctioning mucus or by Over time, CAD can also weaken the heart bronchoscopy. During bronchoscopy, muscle and contribute to heart failure and the doctor gently guides a flexible arrhythmias. tube down your throat to clear your Heart failure means the heart can’t pump airways. blood well to the rest of the body. ○ If a tumor is causing the atelectasis, Arrhythmias are changes in the normal treatment may involve removal or rhythm of the heart. shrinkage of the tumor with surgery, with or without other cancer RISK FACTORS therapies (chemotherapy or ➔ Non-modifiable radiation). ◆ Gender - BEFORE: male population is affected. Breathing treatments NOW: both gender ○ In some cases, a breathing tube ◆ Age - older population have higher may be needed. chance of developing the disease. ○ Continuous positive airway pressure ◆ Family History (CPAP) may be helpful in some ◆ Race people who are too weak to cough ➔ Modifiable and have low oxygen levels ◆ Cigarette smoking (hypoxemia) after surgery. ◆ High blood cholesterol, high triglycerides NURSING INTERVENTIONS ◆ Hypertension Encourage the patient to perform coughing ◆ Uncontrolled Diabetes and deep-breathing exercises every 1 to 2 ◆ Sedentary Lifestyle hours. ◆ Obesity Help the patient use an incentive spirometer ◆ Uncontrolled Stress and anger to encourage deep breathing. ◆ Unhealthy Diet Gently reposition the patient often and help him walk as soon as possible. SYMPTOMS Administer adequate analgesics to control ➔ Chest pain (Angina Pectoris) it may also pain. be felt in the left shoulder, arms, neck, back Humidify inspired air and encourage or jaw. adequate fluid intake to mobilize secretions. ◆ Chest discomfort, heaviness, Use postural drainage and chest percussion tightness, pressure, aching, burning, to remove secretions. numbness, fullness, or squeezing. ➔ shortness of breath 5  ➔ Irregular heart beats or rapid heart beats ➔ Dizziness ➔ Sweating ➔ Fatigue ➔ Nausea ➔ Palpitations DIAGNOSTIC TESTS ECG/EKG - Measures the electrical activity, rate and regularity of your heartbeat. Echocardiogram - Uses ultrasound to assess cardiac structure and mobility. Exercise stress test - Measures heart rate while walking on a treadmill. Helps to determine how well the heart functions while it has to pump more blood. Heart CT Scan - To see calcium deposits in arteries that can narrow arteries. Cardiac Catheterization - To assess O2 levels, blood flow, CO, heart structures and coronary artery visualization. Angiogram - Involves introduction of contrast medium into the vascular system to outline the heart and blood vessels. LABORATORY TESTS Hemoglobin - decreased hdb increased the risk of oxygen deficit in the tissues when cardiovascular disease is present. Total cholesterol - high level can increased risk of heart disease. LDL - too much LDL in the blood causes accumulation of fatty deposits in arteries, which reduces blood flow. HDL - the good cholesterol. Triglycerides - high levels of these can increase the risk of heart disease. Lipoprotein - is a LDL, high level of this increase the risk of heart attack, stroke, blood clots, fatty build-up. DIFFERENT CORONARY ARTERIES Creatinine-Kinase CK-MB - is a cardiac muscle cells that therefore increase when there is damage to these cells.ac muscle cells that therefore increase when there is damage to these cells. 6 PATHOPHYSIOLOGY ➔ Analgesic - Morphine sulfate, may be used in acute onset because of its several beneficial effects. e.gg, causes peripheral vasodilation and reduces myocardial workload, has sedative effect to produce relaxation. MEDICAL PROCEDURES Angioplasty and stent replacement (Percutaneous coronary revascularization) Coronary bypass surgery NURSING INTERVENTION (DRUG THERAPY) Nitroglycerin therapy ○ Assume sitting or reclining position when taking the drug. ○ Caution patient to change position slowly. ○ If to be taken sublingually, offer slips of water before administration because dryness of mouth may inhibit drug absorption. ○ Instruct client to avoid drinking alcohol, to avoid hypotension, weakness, and faintness. ○ Inform patient that headache, flushed face, dizziness, faintness, tachycardia are common side effects during first few doses. ○ Transderm- nitro patch applied OD in the morning. ○ Evaluate effectiveness: relief of chest pain. Beta-adrenergic Blockers ○ Assess pulse rate before administration of the drug, withhold if MEDICAL MANAGEMENT bradycardia is present. A. Pharmacotherapy ○ Administer after meals to prevent GI ➔ Cholesterol-modifying medications - by upset. decreasing the amount of cholesterol in the ○ Do not administer propranolol to blood, especially LDL, these drugs asthma patients because it causes decrease the primary material that deposits bronchoconstriction. on the coronary arteries. ○ Do not give propranolol to patients ➔ Platelet Aggregation Inhibitors - class of with DM because it causes drug that decreases platelet aggregation hypoglycemia. and inhibits thrombus formation. ○ Give with extreme caution to ➔ Beta-adrenergic Blockers - it creases patients with heart failure. blood pressure and heart rate. It reduces ○ Observe for side effects: nausea, the risk for future heart attacks. vomiting, mental depression, mild ➔ Calcium-channel Blockers - it inhibits the diarrhea, fatigue and impotence. transport of calcium into myocardial and ○ Antidote for beta blocker poisoning vascular smooth muscle cells, resulting in is Glucagon. inhibition of excitation-contraction coupling and subsequent contraction. It has systemic Calcium channel blockers vasodilation effect resulting in decreased ○ Assess HR and BP BP. Coronary vasodilation resulting in ○ Monitor hepatic and renal function. decreased frequent and severity of attacks ○ Administer 1 hour before or 2 hours of angina. after meals. ➔ Nitroglycerin - increases blood flow by ○ Food delays absorption and dilating coronary arteries and improving decreases plasma levels of the drug. collateral flow to ischemic regions. ○ The antidote for calcium channel Decreases blood pressure. blockers poisoning is Glucagon. ➔ ACE inhibitors and ARBs - these similar drugs decrease blood pressure and help in Platelet Aggregation Inhibitors preventing the progression of coronary ○ Assess for signs and symptoms of artery disease. bleeding. 7  ○ Avoid straining at stool. To prevent Reduce stress because stress stimulates at rectal bleeding. increase of norepinephrine that causes ○ Should be given after meals to vasoconstriction and tachycardia. Stress prevent GI upsets. also causes anginal pain. ○ Observe for Aspirin Toxicity - tinnitus Allow adequate time for rest and relaxation. (ringing in the ears.) ○ Aspirin may cause bronchoconstriction. Observe for ACUTE MYOCARDIAL INFRACTION wheezing. Otherwise known as heart attack An MI occurs when there is a diminished NURSING INTERVENTIONS blood supply to the heart which leads to Instruct patient and watchers to notify nurse myocardial cell damage and ischemia. immediately when chest pain occurs. Contractile function stops in the necrotic Identify precipitating event, if any: areas of the heart. frequency, duration, intensity, and location Ischemia usually occurs due to blockage of of pain. the coronary vessels. Assess and document patient’s response to This blockage is often the result of thrombus medication. that is superimposed on an ulcerated or Observe for associated symptoms: unstable atherosclerotic plaque formation in dyspnea, nausea and vomiting, dizziness, the coronary artery. palpitations, desire to urinate. MI's are described by the area of Evaluate reports of pain in jaw, neck, occurrence. shoulder, arm or hand usually in left side. Anterior, Inferior, Lateral or Posterior Obtain results of cardiac markers - creatinine, CK-MB, total cholesterol, LDL, HDL, Lipoprotein, hemoglobin and triglycerides as ordered. Place patient at complete rest during anginal episodes Position patient to moderate high back rest to improve chest expansion and oxygenation. Monitor patient's vital signs with pain and O2 saturation. Note the heart’s rhythm. Monitor and obtain ECG results to note abnormal tracings. Provide oxygen as needed or as ordered. Administer vasodilators, beta blockers, calcium channel blockers, and platelet aggregation inhibitors as ordered. Monitor patient’s vital signs every 15 minutes during initial anginal attack. Maintain quiet, comfortable environment. MI CLASSIFICATIONS Restrict visitors as necessary. MI's can be subcategorized by anatomy and Advise patient to minimize emotional clinical diagnostic information. outbursts, worry and tension because anginal pain is often precipitated by Anatomic emotional stress. Transmural and Subendocardial Provide assistance with the activities of patient to avoid over exertion. Diagnostic Stay with patient who is experiencing pain ST elevations (STEMI) and non ST or appears anxious. elevations (NSTEMI). Provide light meals or small frequent feedings. Have patient rest for 1hr after RISK FACTORS meals. The presence of any risk factor is associated with doubling the risk of an MI. HOME TEACHINGS Daily management of hypertension. Take Non Modifiable medicines on a regular basis. Age - increase age more susceptible to Stop smoking. Smoking reduces available hardening of narrowing of BV oxygen to the heart and can precipitate Gender- men higher risk at younger age, angina. It also increases heart rate and after menopausal, women blood pressure. Family history- are at risk due to Follow a heart healthy diet—low sodium, deteriorating estrogen low fat, low cholesterol and high fiber diet. Avoid saturated fats. Modifiable If obese or overweight, lose weight. Smoking Diabetes Control 8  Hypertension Hyperlipidemia Obesity Physical Inactivity SIGNS AND SYMPTOMS Chest Pain The most common initial manifestation is chest pain or discomfort. This is not relieved by rest, position change or nitrate administration. Pain is described by heaviness, pressure, fullness and crushing sensation. Not everyone experiences this sensation PQRST assessment for chest pain P- Precipitating events Q- Quality of pain R- Radiation of pain S- Severity of pa T- Timing Nausea and Vomiting Not everyone will experience this. Vomiting results as a reflex from severe pain. Vasovagal reflexes initiated from area of ischemia. Cardiovascular Changes Initially the BP and pulse may be elevated. Later, BP will drop due to decreased cardiac output. Urine output will decrease Lung sounds will change to crackles Jugular veins may become distended and Investigation - Serum Cardiac Markers ↑ have obvious pulsations Myocardial cells produce certain proteins and enzymes associated with cellular Within the first 10 minutes upon arrival to the functions. hospital: When cell death occurs, these cellular Check vital signs and evaluate oxygen enzymes are released into the blood saturation stream. Establish IV access CPK and troponin Obtain and review 12-lead ECG Take a brief focused history and perform a CPK physical exam Creatine Phosphokinase Obtain blood samples to evaluate initial Begin to rise 3 to 12 hours after acute MI. cardiac markers, electrolytes and Peak in 24 hours coagulation Return to normal in 2 to 3 days Diagnostics Troponin After collecting patient health history, a Myocardial muscle protein released into series of ECG's should be taken to rule out circulation after injury. or confirm MI. These are highly specific indicators of MI. 12 lead ECG can help to distinguish Troponin rises quickly like CK but will between ST-elevation MI's and continue to stay elevated for 2 weeks. Non-ST-elevation MI's. Myoglobin-lacks cardiac specificity TREATMENT OPTIONS The immediate goal for any acute MI is to restore normal coronary blood flow to vessels and salvage myocardium. There are a variety of medical and medicinal therapies to treat an MI. General Treatment MONA Morphine Oxygen 9  Nitroglycerin Follow up care after discharge Aspirin Fibrinolytic Therapy CARDIOGENIC SHOCK Indicated for patients with STEMI MI's. Is the failure of the heart to pump blood Should be given within 12 hours of symptom adequately to meet the oxygenation needs onset. of the body. It occurs when the heart muscle Fibrinolytics will break down clots found loses its contractile power. It most within the vessels commonly occurs as a result of acute Contraindications: post op surgical patients, myocardial infarction (AMI), and left history of hemorrhagic stroke, ulcer disease, ventricular pump failure is the primary result pregnancy, etc. It is the most common cause of death in the post-AMI patient (about 5% to 10% of AMI Cardiac Catheterization patients develop cardiogenic shock), with a A diagnostic angiography which includes resulting mortality of 50% to 60%. angioplasty and possible stenting. Performed by an interventional cardiologist ETIOLOGY with a cardiac surgeon on stand by. 1. Persistent Hypotension. With a marked Percutaneous procedure through the systolic of less than 80-90mmHg or mean femoral or brachial artery. arterial pressure of 30 mmHg lower than baseline because of left ventricular failure. Coronary artery bypass graft 2. Impaired contractility. Causes a marked Surgical treatment where saphenous vein is reduction in CO and ejection fraction. harvested from the lower leg and used to bypass 3. Decreased CO. Results in a lack of blood the occluded vessels. and oxygen to the heart as well as other vital organs (brain and kidneys) Long Term Care 4. Lack of blood and oxygen to the heart Smoking Cessation and lifestyle muscle. Lack of blood and oxygen to the modifications. heart muscle results in continued damage to Aspirin, Beta Blockers and Clopidogrel will the muscle, a further decline in contractile be indefinite. power, and a continued inability of the heart Lipid lowering medication along with diet to provide blood and oxygen to vital organs. modifications. 5. Myocardial Infarction. MI causing extensive damage (40% or greater) to the Nursing Management of MI left ventricular myocardium is the most Nursing interventions for a patient with acute MI common cause. focus on: 6. Mechanical complications. Such as Achieving a balance between myocardial ventricular septal rupture. Contained free oxygen supply and demand: This means wall rupture and papillary muscle rupture that in the acute phase, there is a need to are strongly suspected in patients with increase myocardial oxygen supply by shock, particularly a first MI. oxygen administration to prevent tissue hypoxia. Myocardial oxygen supply can be Clinical Manifestations enhanced by the administration of coronary Confusion, restlessness, mental lethargy artery vasodilators (nitroglycerin). (because of poor perfusion of the brain or Prevention of complications: Nurses need to metabolic encephalopathy). apply cardiac monitoring of patient to detect Low systolic blood pressure (90 mm Hg or early ventricular dysrhythmias. In addition, 30 mm Hg less than previous levels) or nurses should continue to assess for signs MAP