EMERGENCY SERVICES Antonio Costa Antonio Carvalho INTRODUCTION When a patient is hospitalized for a heart disease situation, it is often

a life -threatening situation. Observations of nurses are important for diagnosis and t reatment of the patient. There are no signs or symptoms unimportant. Although th ere are some exceptions, the signs of heart disease in general correlate with th e degree of heart disease present. Antonio Costa Antonio Carvalho Coronary heart disease The coronary artery disease is a progressive and insidious, leading to its narro wing or complete occlusion. Antonio Costa Antonio Carvalho Coronary heart disease The narrowing of the coronary arteries may have multiple causes: • atherosclerosis • thrombosis • dissection • Coronary spasm • Formation of aneu rysms Antonio Costa Antonio Carvalho Myocardial Infarction MI - An area of death cell in the cardiac muscle resulting from ischemia usually caused by complete an d irreversible occlusion of a coronary artery. Antonio Costa Antonio Carvalho Angina Angina pectoris - is a syndrome clinically characterized by paroxysms of pain or pressure in the anterior part o f the chest that arises as a result of inadequate coronary blood flow and myocar dial hypoxia. (There is a disease but a symptom of coronary heart disease). Antonio Costa Antonio Carvalho Usual location of anginal pain The upper anterior chest Retrosternal area radiating to the neck and jaw Retrosternal area radiating to M. Left Sup Epigastric Epigastric with radiation to the neck and jaw neck, jaw and M. Sup Shoulder and left limb Intra-scapular Antonio Costa Antonio Carvalho DIAGNOSIS • Signs and symptoms • ECG Changes

• Changes enzymatic Antonio Costa Antonio Carvalho Signs and Symptoms Pain with or without irradiation Pallor marked Sweating, moist skin and viscous Dizziness Nausea Bradycardia Hypotension Antonio Costa Antonio Carvalho - Electrocardiographic Changes • Changes in T wave • Elevation of the ST segment. • Later onset of abnormal Q w aves. Antonio Costa Antonio Carvalho Electrocardiographic changes Heart strong and regular Able to supply oxygen to the tissues that need Antonio Costa Antonio Carvalho Electrocardiographic changes Atherosclerosis reduces the blood flow and consequently a decrease in oxygen sat uration in the myocardium, which can lead to angina. (Change in ECG) Antonio Costa Antonio Carvalho Electrocardiographic changes The artery obstruction deprives oxygen area of the myocardium, leading to his de ath. (Changing its electrical conductivity, producing ECG changes) Antonio Costa Antonio Carvalho Electrocardiographic changes may be necessary to carry out stress ECG, echocardi ography or angiography. Antonio Costa Antonio Carvalho Enzymatic changes The enzymes studied in myocardial necrosis are: CPK (creatine phosphokinase) and its MB fraction specifies infarction. glutamic-oxalacetic transaminase) DHL (LDH) Troponin Antonio Costa Antonio Carvalho GOT ( Anxiety Dyspnea Tachycardia /

TREATMENT Objectives: • Relieve symptoms by decreasing the incidence. • Maintain the largest possible amount of myocardium. • prevent, divert and treat complications. Antonio Costa Antonio Carvalho

Nursing care to the sick coronary • Patient with angina • Patient with EAM Antonio Costa Antonio Carvalho Nursing care to patients with angina Place patient in comfortable position (semi-sitting) to reduce pain and anxiety of the patient, through the prescribed therapy (nitroglycerin) transmitting calm and safety evaluation of the sick to other vital parameters determine / confirm the diagnosis by immediate implementation of ECG features and evaluate kind of pain and monitoring of heart rhythm steady and continuous Antonio Costa Antonio Carvalho Nursing care to patients with angina Collection of specimens for analysis, providing rapid dispatch to the laboratory Screening signs and symptoms of possible complications (EAP) administration of prescribed therapy to promote physical rest Antonio Costa Antonio Carvalho Place peripheral venous catheter for administration to maintain a therapeutic en vironment as calm as possible Nursing care for patients with AMI Place patient in comfortable position (semi-sitting) Maintain an environment as calm as possible, avoiding running and monitoring violations of rhythm and heart rate constant and permanent, evaluation of other vital parameters Promote deter mination / confirmation of diagnosis by immediate implementation of ECG Reduce p ain and anxiety of the patient, through the prescribed therapy (Morphine) transm itting the patient calm and secure Find rhythm disturbances and heart rate requi ring emergency treatment (arrhythmias) Antonio Costa Antonio Carvalho Evaluate characteristics and type of pain Nursing care for patients with AMI Administration of oxygen by nasal cannula (3-5 L / min) Set the peripheral venou s catheter for therapeutic administration to promote home absolute physical obse rvation of changes in the patient's psychological state administration of other therapies prescribed Antonio Costa Antonio Carvalho Collection of specimens for analysis, providing rapid dispatch to the laboratory administration of thrombolytic therapy when prescribed Screening of signs and s ymptoms of possible complications (arrhythmias, EAP) bladder catheterization and control of water balance Nursing care for patients with AMI Emergency car prepared for possible complications Prepare patient to the coronar y care unit admission show responsiveness to their questions Promote monitoring of nursing the sick to the coronary care unit coronary and examinations as a dia gnostic maintaining continuous monitoring. Antonio Costa Antonio Carvalho Search for capillary blood glucose screening for diabetes patient preparation fo r coronary catheterization, explaining the procedures (and Trichotomy premedicat ion)

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