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Treatment: For single occluded artery P-ercutaneous T- ransluminar C- oronary A- ngioplasty A catheter is inserted via femoral artery to the heart, inflate a balloon to crack a plaque. Multiple occluded vessels: C oronary A arterial B bypass A and G raft surgery

Nursing Mgt before CABAG 1. Deep breathing cough exercise 2. Leg exercise Complications of CABAG 1. Pneumonia

2. Pulmonary embolism 3. Respiratory obstruction

2. ANGINA PECTORIS chest pain radiating to the arm but usually relieved by REST and NTG. SIGNS AND SYMPTOMS: C hest hand clutching ( Levines sign ) 1st s. H eavy, tight and crushing E 4 Es S hort duration, stabbing, substernal T ravels to the back, axilla, neck and jaw but

treated with rest and NTG Predisposing Factors: H ypertension, hyperlipidemia,

hypothyroidism,DM E elevated blood cells A therosclerosis R al contraceptives T hromboangitis obliterans S moking, sedentary lifestyle,

obesity Myocardial Infarction or Heart Attack The process by which areas of myocardial cells are permanently destroyed Occurs when myocardial tissues are: abruptly and

severely deprived of Oxygen Myocardial Infarction

A diseased condition caused by: Reduced blood flow in the coronary artery, due to: Atherosclerosis Occlusion of an artery by an: Embolus Thrombus

Location / Types of M.I. Posterior Wall / Lateral Wall M.I. Circumflex artery blocked

Location / Types of M.I. Inferior Wall M.I. Right coronary artery blocked

Clinical Manifestations

1. Cardiovascular Chest pain / discomfort Palpitations Elevated BP ECG will show: o o o Tachycardia Bradycardia Dysrhythmia

Clinical Manifestations

2. Respiratory Shortness of breath Dyspnea / Tachypnea

Crackles Pulmonary edema 3. Gastrointestinal Nausea Vomiting Clinical Manifestations

4. Genitourinary Decreased urinary output 5. Skin Cool, clammy skin Diaphoresis pallor, Cyanosis Coolness of extremities Clinical Manifestations

6. Neurogenic Anxiety Restlessness Light headedness Headache Visual disturbances Altered speech Altered motor functions Altered LOC Clinical Manifestations

7. Psychosocial Feeling of fear Denial PAIN PAIN: PAIN

1. Characteristics: Severe Immobilizing Described as: o o o o o 2. Location Substernal Retrosternal Epigastric 3. Radiation Neck Jaw Arm Back Diagnostic Tests Heaviness Pressure Tightness Burning PAIN:

1. Assessment based on presenting symptoms Laboratory results Patients history Previous illness Family history Description of presenting symptoms

2. Electrocardiogram Provides information that assist in diagnosing AMI Classic ECG Changes: 1) T wave inversion 2) ST segment elevation 3) Abnormal Q wave PAIN:

2. Electrocardiogram 3. Electrocardiogram : T wave inversion 4. Electrocardiogram : ST Segment Elevation 5. Electrocardiogram : Abnormal Q Wave 3. Laboratory Examinations: Serum Cardiac Markers CK MB (Enzyme) Increases in 3 6 hours Peaks in 12 18 hours Returns to normal within 3 4 days Cardiac Troponin T (Protein) Increases in 7 14 hours

Persists for 5 7 days 4. Echocardiogram 5. Magnetic Resonance Imaging 5. Angiography Goals: Minimize myocardial damage Preserve myocardial function Prevent complications Detect percentage of blockage Type of MI

Medical Management

Pharmacology: 1. Thrombolytics 2. Analgesics 3. ACE Inhibitors 2. Thrombolytics Dissolve and do lysis of the thrombus in coronary artery Given up to 12 hours of onset of chest pain Should be given within 1 hour after onset of chest pain Example: 2. Analgesics streptokinase Urokinase t PA Alteplase

e.g. Morphine sulfate Nitrates IV 4 ampules in 100ml normal saline Oral can take 3 tablets at one time Give second tab after 10 minutes when pain is relieved 3. ACE Inhibitors Beta Adrenergic Blockers Calcium Channel B

Complications of M.I.

1. Dysrhythmias 2. Cardiogenic Shock 3. Heart failure 4. Pulmonary embolism 5. Recurrent MI 6. Dresslers Syndrome (Pericarditis) 7. Ventricular Aneurysm 8. Thromboembolism Nursing Management

Acute Phase 1. Assessment of chest discomfort 2. Assess vital signs 3. Cardiovascular status and maintain cardiac monitoring 4. Semi fowlers position 5. Oxygen at 2 to 4 liter per minute

6. IV access 7. Administer nitroglycerin as prescribed 8. Administer morphine sulfate as prescribed 9. Obtain a 12 lead ECG 10. Monitor thrombolytic therapy 11. Monitor signs of bleeding 12. Monitor laboratory values 13. Monitor for complications related to the MI 14. Monitor for cardiac dysrhythmias 15. Assess distal peripheral pulses and skin temperature 16. Monitor I and O 17. Assess respiratory rate and breath sounds for signs of heart failure 18. Provide reassurance to the client and family Following Acute Phase 1. Bed rest for the first 24 to 36 hours 2. Bedside commode 3. Provide range-of-motion exercises to prevent thrombus formation and maintain muscle strength 4. Progress to dangling legs at the side of bed to the chair for 30 minutes three times a day 5. Progress to ambulation in the clients room and to the bathroom then the hallway 3x a day 6. Monitor for complications 7. Encourage to verbalize feelings regarding the MI