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Often occurs in the left ventricle

Severity depends on area of heart


involved
Healing process
1
st
24 hrs: inflammatory well established
4-10 days: necrotic zone well-defined
10-14 days: formation of scar tissue
foundation

Assessment
Severe, substernal and crushing pain
unrelieved by nitroglycerin
Dyspnea
n/v, digestion, pallor, decrease BP,
tachycardia, syncope
Dx
Cardiac isoenzymes: CPK & troponin
WBC
B-type natriuretic peptide
Immediate Treatment of MI
MORPHINE
OXYGEN
NITROGLYCERIN
ASA
Nursing Intervention
Decrease pain & increase myocardial oxygenation
Reclining w/ head elevated
Nitroglycerin SL
Morphine
ASA
Evaluate pain & overall response
CBR w/o TP
NPO initially
X valsalva; increase fiber

Assessment
Left-sided HF
Blood backs up into left atrium &
pulmonary veins
Pulmonary congestion
Right-sided HF
Blood backs up into systemic circulation
Precipitated by LHF

Manifestations
Breathing pattern
problems
Paroxysmal
nocturnal dyspnea
Cough
Increase in PAP (
15-25/5-15 mmHg)
PAWP (4-12 mmHg)

Hepatomegaly
Pitting edema
Dependent edema
Ascites
Inc. CVP (4-10 mm
of H2O)

Management
High Fowlers or semi-Fowlers
6-8 Lpm then intubate
Morphine SO4
Cardiac glycoside/digitalis prep
Digoxin, Cedilanid, Dislanoside
Diuretic
Low sodium
Fluid restrictions (5lbs=2L)


Assessment
Oliguric
<400 ml/day
Increase BUN, creat., uric acid, K & Mg; M. acidosis
10-15 days
Diuretic
Increase to 3-5 ml/day; urine very dilute
BUN stops increasing
2-3 wks
Recovery
3-12 mos
Manifestations
Fixed specific gravity (intrarenal & postrenal);
high (prerenal)
Elevated BP
Azotemia
Uremic frost
M. acidosis
Kussmauls
Anemia
Hypocalcemia, hyperphosphatemia, hyperkalemia


Management
Low Na
antiHPN drugs
Skin care
NaHCO3
Epogen
AlMgOH
Na polystyrene sulfonate (Kayexalate)
Glucose & insulin
Dialysis
Hemodialysis
Prep
Check v/s
Weigh client
Withhold antiHPN
Check serum K+ det.
Fistula
External AV shunt 6-12mos
Internal AV fistula -- 3yrs
Subclavian/femoral cannula
Common cx
Steal syndrome
Vascular insufficiency w/ diminished P,
pallor & pain distal from site
Patency
Check loud bruits, thrills & warmth
Disequilibrium syndrome
Rapid removal of urea from blood rather
than brain causing cerebral edema
HA, n/v, confusion convulsion


The Dialysate
Warmed at 37.4
Primed w/ heparin
Position of comfort
3-4hrs 3-4x/wk
Observe cx
Infxn
Pulmonary embolism (sudden severe chest
pain, tachypnea, dyspnea) d/c
Disequilibrium

Post-Dialysis
Check v/s
Weigh
Call lab for extraction of serum
K det. (if elevated, shift to PD)
Peritoneal dialysis
Prep
Peritoneal cath immediately below umbilicus
Empty bladder
Cleansing enema
Prep equipment
Dialysate (37-38 deg C) urea clearance & comfort
PD sheet
Drainage bag
Inflow clamp & outflow clamp
Semi-Fowlers
Periods
Installation 5-10mins
Dwelling/equilibriation 30-45mins
Drainage 30-45mins

1exchange PD = 1H40mins
1 exchange HD = 3-4H

Advantage
Done
anywhere
Cheaper
No special
machine
Disadvantage
Slow tx
CAPD
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
Installation
20-30mins
Open clamp (inflow)
May complain back pain
Will disappear in a few hrs

Dwelling
4-8 H
Close clamp (inflow) osmosis & diffusion
Complications
Peritonitis
Boardlike abd, fever, pallor, v/s, diaphoresis
d/c
Add dialysate w/ antiB & glucose ( osmotic
pressure for solid removal)
Respiratory difficulty &/or respiratory
distress
Drain out drainage
Semi-Fowlers
Drainage
4-8H
Open outflow clamp
Observe color & amount
1
st
2 exchanges blood-tinged
N color clear
Bright red hemorrhage
Dark drown bowel perforation
Cloudy infection
No drainage dislodged

During the absence of drainage:
Reposition to semi-Fowlers
Press/massage abdomen w/ palms of hands & turn from
side to side
Kink cath

O>I
Advantages
More independent
Diet is liberal
Alleviates sx
Time for dialysis

If K+ is still , RENAL
TRANSPLANT
Young donor + functional kidney
Cx
Infection: steroids (Azathioprine, Prednisone)
Graft rejection
Hyperacute 1
st
48H postop
Acute 2-3wks
Chronic several mos to yrs
Sx: BUN & creat. & wt., absence of urine, tenderness on site