constriction

BP =

Cardiac Output x TPR Total Peripheral Resistance pilation Symptoms

. Persistent chest pain <15 mins

Cardiac Output =
Stroke Volume
(inotrophic) x Heart Rate (chronotrophic z .

Upset feeling
External fascicles KI .
3
Lightheadedness
:

Internal fascicles :

Myosin Actin (from myogenic cells( 4 Shortness of

. breath
-

need glucose- needs oxygen

to be used 5 .
Excessive sweating

Coronary Artery Diseases CAD Nursing management

I . CBR ↓ cardiac
work load
Non modifiable risk factors 2 .
NPO
Gender ↓ 40 -

M 3 .

Oxygen-I flow 4-GL/min

Age 440 F 4 Diet (after the attack)
-

Family history ↓ fat

↓, cholesterol
Modifiable risk factors ↓ Sodium
stress 5 .
Medications as ordered

Hypertension a .

Nitroglycerin (drug of choice)

:

vasodilator

Obesity Acute
-

Elevated Cholesterol <200 mgldL Route

Sublingual highly Vascular
:
:
·

Smoking ·Onset 1-3 mins

:

Duration :

30 mins

Angina
I
Pectoris I
·burning or stinging sensation -

decrease pain
by sippingH 8
.

pain chest ·

Take max of 3 closes at 5 min interval

pain in the chest caused from coronary insufficiency ,

in the absence
of myocardial infarction Maintenance
Nitropatch
-
:

applied OD in am after bathing

-

Types : -

rotating site
:

to prevent tolerances irritation

1 . Stable -

apply in less / non-hairy site

-

<50% obstruction

-precipitating factors :
-

Store dry dark place :

a exercise replace stocks open

3
·

mos
:
-

b. extreme
temp sealed 6 mos
:
-

c . excessive
eating
-

Evaluate effectiveness relief :

of
pain
d emotional stress Common side effect Hypotension
:
-

relieved by rest
↓ .

B-adrenergic blocking agents

. Unstable (pre-infarction" ,
"crescende" "acute coronary
, insufficiency") -

Propanolol Metoprolol ,

50 % obstruction SIE Bradycardia

- :

↑attacks
-

T freqvency C .

Ca-channel blockers
-

i
intensity
-

Verapamil Nifedipine , ,
Kiltiazem
Iduration SIE Hypotension
-
:

relieved by-DOC Nitroglycerin

:
-

d Platelet .

aggregating inhibitors
-

3 .
Prinzmetal's "variant Atypical type
-

ASA , Dypiridamol Ticlodipine .

no obstruction >325mg 40 OD for two weeks

pain bec of vasospasm and
prolonged physical stress SIE :

Bleeding Ototoxicity (tinnitus( ,

also called workaholic heart syndrome

·

relieved by rest e .

Anticoagulants
Heparin Warfarin
-

Patho : SIE Bleeding :

partial obstruction--yblood supply ->Yoxygen-> spasm-release of inWarfarin

prostaglandin bradykinin -

pain stress yung katawan - acti-

- Route
·

NISC :Oral
ration of SNS ->
stimulating adrenal medulla -> release of epi nor- Kematoma
epi->vasoconstriction Advantage Fast acting Longhalf life
:
:

:l
Monitor
:

PTT

N
Protamine Sulfate e :
6 .

Prepare for surgery if indicated 3 .

Refractory
1
-

Percutaneous Transluminal Coronary Angioplasty (PTCA) Time specific timing

:

no

single vessel Cradial artery) Intravascular Stenting to prevent restenosis Pathophysiologic change infarction
· - :

Vita1999nS :

Myocardial Infarction ECG :

Deep Q-waves

myocardial cell necrosis

-

Occlusion: Nursing Management

-

caused
by coronary artery obstruction atherosclerosis
-

1 .
CBR5 BPP
leads to anaerobic
glycolysis 2 NPO
-

3 . Administer Oz as ordered
Patho 4 .
Establish an Nine =

NSS/D5WKNO
Total obstruction -> blood anoxia ->body will compensate Medications ordered during crisis stage
no
supply -> 5 .

as

through anaerobic glycolysis -

will produce glucose ->

to
produce 1 .

Morphine SOy- DOC

myocin and actin-waste product is lactic acid-pain - stress- -

I
I-2Mg ,

activation of SNS-stimulate adrenal medulla release of

epid norepi natural narcotic
-

-> vasoconstriction b Sedative .

C .

anti-anxiety
Symptoms d .

vasodilating effect
Persistent chest pain 15 mins SIE respiratory depression
:

. .

z .

Upset feeling
-

antidote Naloxone I I 1
:
:

.
3
Lightheadedness
4 Shortness of breath
.
c .

Nitroglycerin
5 Excessive sweating -to prevent secondary arterial
spasm
.

SIE YBP :

Dianostic Studies
.
Enzymes 3 .

Aspirin
·

Most sensitive Troponin I

:

625
mg OD PO for weeks
-

elevates in 30 mins
4 .

Thrombolytics
·

Most Indicative (K :
-

MB -

G divided doses ein 4hours

elevates in 2-4 hours -check for clotting time

-

antidote Amicar :

aminocaproic acid
·

Most Definitive ECG :

can determine the stages of MI J . Additional drugs

a . ACE inhibitors
·

LDH Lactic Dehydrogenase b Beta blockers .

1
N LDH =

< LDH2

Ab-LDA1> LDH2 LDA flip ->

multi system involvement ->
doctor will Prepare for surgery if indicated
=

order more laboratories :

Coronary Artery Bypass Graft CABG
aBUN3 Crea Kidney multiple blood vessels
=

b AST BALT Liver revascularization

:

.
for

C .
GCS-4 :
Brain -

Graft sources

Saphaneous vain
·

Stages ·

Internal mammary artery

·Radial artery
: .

Compensatory
heart is damaged but vital
organs are protected
-

Time first 4 :

crisis-24 hours

Pathophysiologic change Ischemia

:

Vital signs Increased :

ECG ST-Elevation :

2 .

Decompensatory
heart is
okay/resting but vital organs are damaged
-

Time after 4-24 hours :

Pathophysiologic change Injury

:

VitaI signs Decreased :

ECG ST and T-wave

depression inversion
:

doc will order LDH

Congestive Heart Failure CHE 3 .

Dilating Agents Vasodilators

3 ps to y afterload
problem -

Pump -heart -Examples :

Passenger blood .
Nitroprusside Nipride
-

Passageway-blood vessel 2 Hydralazine Apresoline

.

3
Nifedipine .

Diagnostic Procedures 4 Captopril .

. CXR=
cardiomegaly
2 .

Echocardiogram
=

determines actual location 4 . Diet and Lifestyle Changes

3 .

Coronary catheterization: ↑CYP <central venors pressure) a . Diet

·

↓Na
Management · ↓ fat
·

↓ cholesterol
.Digitalis Therapy ↑ fiber
·

-major theral x
1
-

c) inotrophic
=

/cardiac contractility b Lifestyle .

Chronotrophic heart rate to prevent immature ventricular adequate rest

= : ·
-

contraction quit smoking

·

Monitor HR expected to have bradycardia limit alcohol

-
:
-
:

: level if IK= Digitalis Toxicity -

ready antidote Digibind ·coping relaxation
:
=

=Early SISX Gl :

Vomiting
:

Nausea
·
Diarrhea Abdominal cramps
:

Left-Sided Heart Failure

Anorexia -pulmonary and
oxygenation
-

Late SIx Visual Halos around:

light
·

Yellow I green vision Signs

CV .:
Dysrhythmias Cough
Examples Hemoptysis
-

2 .

↓ .
Lanoxin Digoxin 3
Orthophea .

2 .

Crystogidin Digitoxin 4 .

Pulmonary edema
3 .
Lanatoside Cedilanid ( -

dyspnea
4. Deslanoside CedilanidD pink frothy spotur
-

bilateral crackles

2 .
Divretic Therapy
-

to decrease cardiac workload by reducing circulating By Right Sided Heart Failure

Examples :

systemic circulation
-
-

1 .
Thiazides oral :

Chlorthiazide (I
CivrilEsix Signs
·

Hydrocklorthiazide dril , Hydrodivril Hepato/ Hepatosplenomegaly

·

c .

Edema-pitting
Loop Divretics oral IV Ascites
:

2 .

,
.
3

Furosemide Lasix 4 .
Distended jugular vein
·

Bumetamide Burmex
Acute Biological Crisis ABC

3 . Potassium -

Sparing . Myocardial infarction

Shock
Spironolactone Aldactone 2
·

Triamterene Dyrenium 3 . BUrnS

Management
. Diet ↑K except in K-sparing
:

2 130 monitoring expect purine output

:

3 Undesirable SIE hypotension , hypokalemia

.
:

4 Record wt weight is expected

.
:

5 Elderly precautions BUNS Crea

:

6 Take early morning or early afternoon to

.
:

prevent nocturia
7
Ingest food first to prevent Gl upset
:

8 Caffein restrictions
.

9 .

Slowly administer if I route to prevent:

phlebitis
 Shock Anaphylactic Shock
BP =

Cardiac Output x
constriction

TPR Total ceril

1 Cheral Resistance Dilation Allergens extrinsic-body will response by sending IgE ->
intrinsic
-

Is an life-threatening condition in which body tissues

acute , will bring allergen to skin through eosinophils rashes >708 ->

inadequately perfused or unable to utilize oxygen

muchwilldestroy macen ri n mail Precipitatetheproduction
are .

Hypovolemic Shock stages of Shock

-

inadequate amounts of blood volume in the intravascular space

-

low blood volume 1 .

Compensated/Non-progressive
most common vital organs remain
adequately perfused
-
-

Cardiac output problem

-

Causes :
2 .

Decompensated/Progressive
.
Dehydration organs become underperfused
vital
-

.
Hemorrhage -

sensatory mechanisms fail resulting in systemic

comI ,

3 .
35d space shifting manifestations

Cardiogenic Shock s . Irreversible

-heart unable to
pump enough blood -

Therapeutic intervensions become useless

-

most dangerous
-

Death eventually occurs

cardiac output
problem
-

causes :
Physiologic Response to Shock
Myocardial infarction 1 achycardiA heart
-

2 TAC
2 .
K conditions hy<nea
I
.

lungs
a
Hypokalemia flacid heart prominent U-waves Physiologic shunting brain
:

3
-

.
.

b
Hycerkalemia spastic heart fall peaked T-waves
.
-
:

, a .
Vasoconstriction
3 . Electrecution b
. Compensatory mechanism
c . SNS activation
Obstructive Shock 4 Skin .

colors Temperature change

blood vessels are
physically or mechanically obstructed Early Pallor cold temperature
- :

least common Late Cyanosis

:
-

Septic Warm ? flushed skin

cardiac output problem
:

causes :
5 .

Hypotension
1 Severe atherosclerosis first indicator of failing compensation
-

2 .

Dislodged stent 6 .

Coagulation abnormalities
3 Severe vasospasm Most shock clotting
:

Septic shock bleeding bec of platelets

:

C
I istributive Shock .
Hyperglycemia liver
-

related to systemic vasodilation -

glycogen is broken down into glucose

-

involves alterations in the distribution of intravascular 8 Fluid shifts

.

volume 9 Activation of RAAS

.

kidney
TPR problem powerful defense in shock
most but late compensation
-

a
-

Types : ↓ urine output

oliquria 130ccltr)
-

>activation of Juxtaglomerular Apparatus

to become Renin - will stimulate
: .

Neurogenic spinal in
/ uries induced by trauma pain -> will convert Renin Substrates lungs
2 .

Septic infection the production of ACE Angiotensin Converting Enzymes ->

will convert
3
Anaphylactic allergy the Angiotensin' liver comes from Angiotensinogen All together with ->
-

ACE will become Angiotensin can cause Vasoconstriction YTPR-TBP ->

->

Neurogenic Shock Stimulates adrenal cortex

releasing mineralocor ->

↑Noxious Stimuli
1

Cirritatingchemicals) injury
-

release of prostaglandin ticoids Aldosterone -

retains sodium-4 water - blood volume-

and bradykinin : N inflammation ->

:
healing process heart will output ->TBP cardiac to reverse
hypotension or shock
- severe
pain -- loss of
vasogenic reflex
-
systemic vasodilation - 10 End
organ damage
.

↓ TPR - BP- shock a Kidney

problem .

b Hepatic
dysfunctions .

Septic Shock c . Gl
problems
↑Pathogens microorganisms bacterias viruses , ,
reaches blood --stimulati d .
Nutritional deficits
hypothalamus--will cause CNS
-

ng the release of
pyrogens
-> stimulates e .

damage
called ->vasodilation
sudden elevated temperature hyperpytexia
I
->
TPR -BP ->
Septic shock

can cause destruction of platelets

->
bleeding
First Aid and Preventive Management

Proper Position
Safe position supine
:

croves blood circulation modified trendelenburg

Imy
:

Improves breathing high fowlers or orthopneic

:

For nauseated or
vomiting victim
:

side
lying or recovery

Proper Body Heat

Maintain body
temperature
·

-prevent cers
I ciring
-prevent chilling
Collaborative management
·Assess the primary cause of shock
·Monitor :

130 urine output

=

a .

b Central Venous Pressure

.

to measure the pressure on the R A .

Line Central Line - Subclavian rein

:

-
Superior Vena Cava--R A .

Normal Manometer : :

4-10cmH2O

Gauge :
7-14 mmHg
Result :

Increase :

Fluid volume excess

Decrease Fluid volume deficit (expect)

:

c . Vital signs =

915 mins

Other Priorities
Maintain airway provide cardiac and
and
pulmonary support
·

·IF as ordered
it prob in fluids NSS
:

if prob in FRE Lactated Ringer contains Na K Ca

:

, ,

if prob in bleeding Blood transfusion :

/NSS isotonic

x LR bec it contain Ca a
clotting factor
=

isotonic
x D5 W isotonic in bottle

hypotonic in body
provide supportive care as indicated
·

Institute management for specific cause

" .

Hypovolemic
Dehydration
·

:
fluids
Hemorrhage BI
=

·
3rdspace shifting
:

Colloids

.
2
Cardiogenic
·Myocardial Infarction Morphine SO4 :

:
NTG

Aspirin
:

-Thrombolytics
·

Potassium conditions :

↓K =T
=4K diet :
K dief -

I insuline D5W
-KC =Kayexalate Dialysis
=

·
Electrocution

3 .
Distributive
Neurogenic pain relief
·

Septic :
antibacterial

Anaphylactic mast cell stabilizers Cromolyn Na

:

=antihistamines
-steroids
epinephrine DOC
-

calibrate dose- Epipen