Professional Documents
Culture Documents
Acute Biological Crisis
Acute Biological Crisis
RN
Clinical Instructor
Acute Biologic Crisis
Condition that may result to patient
mortality if left unattended in a brief
period of time.
Condition that warrants immediate
attention for the reversal of disease
process and prevention of further
morbidity and mortality.
Conditions that can be
considered ABC
Heart failure & Dysrhythmias
Respiratory Failures & Acute
Respiratory Distress Syndrome
Renal Failure & End Stage Renal
Disease
Burns
Conditions that can be
considered ABC
Hepatic Coma
DKA/HHNK
Thyroid Crisis & Adrenal Crisis
Multi System Organ Failure & Shock
Fatigue
May be due to Anemias or related to
decreased Cardiac Output
Cardiovascular Assessment
Palpitations
Awareness of rapid or irregular heart beat
Autonomic Nervous System and Adrenal Glands
response (stress)
Syncope
Transient loss of consciousness
Due to decreased cerebral tissue perfusion
Cardiovascular Assessment
Edema
Due to: Increased Hydrostatic Pressure
(HP)
Decreased Colloidal Oncotic
Pressure (COP)
Obstructed Lymphatic or
Vascular System
Related to Inflammatory reaction
Types of Edema
Bilateral edema
= CHF or Renal Failure
Unilateral edema
= Vascular or Lymphatic obstruction
Non-pitting edema
= Inflammatory
Pitting edema
= HP and
COP derangement
Cardiovascular Assessment
Skin
Color, temperature, hair growth,
nails, capillary refill
spooning of fingers /clubbing of
fingers
Clubbing of Fingers
Cardiovascular Assessment
Heart rate – 60-100
Rhythm – regular or irregular
Bruits and Thrills – murmurlike; vascular
in origin
- palpate a thrill, auscultate a bruit
Blood Pressure
Jugular venous pressure
Cardiovascular Assessment
Cardiac rate and rhythm
Tachycardia = ↑ 100 beats/minute
Bradycardia = ↓ 60 beats/minute
Arrhythmias = irregular rate and
rhythm
Cardiovascular Assessment
S1 closure of AV valves (lub)
S2 closure of SL valves (dub)
S3 & S4 diastolic filling sound
S3 heard after S2
if present suspect CHF; common
S4 is heard prior to S1; if present suspect non-
compliant ventricles although this is common
among the elderly.
Cardiovascular Assessment
Murmurs - turbulence of blood flow; if
positive watch out for FVE; normal until 1 year
old
Pericardial Friction Rub -“squeaking sound”;
suspect pericardial effusion if this is heard
Muffled Heart Sound - if positive rule out
Cardiac Tamponade and other similar problems
like Effusion
Laboratory & Diagnostic Test
Complete Blood Count- RBC suggest tissue
oxygenation.
Elevated WBC may indicate infectious heart
disease and MI.
Erythrocyte Sedimentation Rate (ESR)- Its
is elevated in infectious heart disorder or MI.
Normal range: Males: 15-20mm/hr
Females: 20-30 mm/hr
Laboratory & Diagnostic Test
Blood Coagulation Test:
1.Prothrombin Time (PT, Pro Time)- It measures
time required for clotting to occur. Used to
evaluate effectiveness of COUMADIN. Normal
range 11-16 secs.
2.Partial Thromboplastin Time (PTT)- Best
screening test for disorders of coagulation. Used to
determine the effectiveness of HEPARIN. Normal
Range: 60-70 secs.
Laboratory & Diagnostic Test
Blood Urea Nitrogen (BUN)- Indicator of
renal function
Normal Range: 10-20mg/dl (5-25mg/dl is also
accepted).
Blood Lipids:
1.Serum Cholesterol: 150-200mg/dl
2.Serum Triglycerides: 140-200mg/dl.
Laboratory & Diagnostic Test
Serum Enzymes Studies
1.Aspatate Aminotransferase(AST)- Elevated level
indicates tissue necrosis. Normal Range: 7-40mu/ml
2.CK-MB- Elevated 4-6hrs from the onset of
infarction; peaks 24-36 hrs. returns to normal 4-7
days.
Normal Range: males: 50-325mu/ml; Females: 50-
250mu/ml
Laboratory & Diagnostic Test
Serum Enzymes Studies
3. Lactic Dehydogenase (LDL)- Onset: 12hrs;
Peak: 48hrs; returns to normal: 10-14 days
4. Hydroxybuterate Dehydroxynase (HBD)- it is
valuable in detecting silent MI because it is
elevated for a long period of time.
Onset: 10-12hrs; Peaks: 48-72hrs; Returns to
Normal 12-13 days
Laboratory & Diagnostic Test
Serum Enzymes Studies
5. Troponin- Most specific lab test to
detect MI. Troponin has 3
compartments: I,C, &T .
Troponin I persist for 4-7 days.
Angina Myocardial Infarction
Chest Pain- tightness & Severe crushing,
heaviness stabbing chest pain
Relieved quickly:3- Not relieve by rest and
15min by rest or medication
sublingual nitrogen.
Initiated by physical Pain last longer >20min
exertion or stress
Radiation may or may May or may not have
not be present radiation of pain
Frequently associated
with shortness of breath
Laboratory & Diagnostic Test
Serum Electrolytes/ Blood Chemistry:
1.Sodium (Na)
2.Potassium (K)
3.Calcium (Ca)
4.Magnessium (Mg)
5.Glucose
6.Glycosylated Hemoglobin (Hemoglobin A1c)
Laboratory & Diagnostic Test
ECG/ EKG- ST segment elevation and T
wave inversion
Diagnostic Test
Radiologic Findings
Chest X-Ray
Normal
Cardiomegaly
Signs of CHF
Diagnostic Test
Hemodynamic Monitoring
Swan-Ganz Catheterization
Right side of the heart
Pulmonary artery pressure
Pulmonary artery occlusive pressure
Right atrial pressure
Cardiac output
Swan-Ganz
Catheterization
Diagnostic Test
Coronary Angiogram
allows to visualize
narrowings or
obstructions
therapeutic measures
can follow
immediately.
Goal:
Pain relief
Reduction of myocardial
oxygen consumption
Prevention and treatment of
complications
Intervention
Admit to the CCU/ ICU
Activity
Day 1: bed rest, if stable
Day 2-3: bed rest, but patient
may be allowed to sit on a chair
for 15-20 minutes
Early mobilization is
recommended for
uncomplicated AMI
Intervention
Monitoring Vital Signs
First 6 hours- q30-60 minutes
Next 24 hours- q 2 hours
Thereafter q 4 hours
Diet
NPO: 1st 24 hours
If stable low salt, low cholesterol diet
Intervention
IV Fluids
D5W to KVO
If unable to take food/
fluid per orem
1000ml/8 hours
K supplement
Intervention
Pain Medication
Morphine SO4 (2-5mg/IV dose)
Potent analgesic
Peripheral venous vasodilation
discharge
Tranquilizres
To decrease anxiety
Diazepam (5-10 mg per IV/orem)
Laxative
To prevent straining during
defecation
Lactulose (HS)
Drugs to Limit Infarct Size
Beta Blockers
Hyperdynamic states, HPN w/o
evidence of heart failure
Reduce myocardial oxygen
consumption by decreasing: BP. Heart
Rate, Myocardial Contractility and
calcium output.
Ex: Propranolol, Metoprolol, Atenolol
Nursing Consideration:
1.Assess Pulse Rate before administration;
withhold if bradycardia is present.
2.Administer with food, may cause GI upset.
3.Do not administer with asthma it causes
Bronchoconstriction.
4.Do not give to patient with DM, it causes
hypoglycemia.
5.Antidote for Beta Blocker poisoning is
Glucagon
Nitrates
Act by augmenting perfusion at the border
of ischemic zone.
Generalized vasodilation
Reducing myocardial O2 demand
Lowering preload
Lowering afterload
Ex: IV Nitroglycerine, Sublingual
Niotroglycerine, Oral/Transdermal
Nitroglycerine
Nursing Considerations:
1.Only a maximum of 3 doses at 5 min. interval.
2.Offer sips of water before giving it
sublingually.
3.Store the medication in a cool, dry place; use
dark /amber container.
4.If side effects is noticed do not discontinue the
drug this is usual in the first few doses of
medication.
5.Rotate skin sites for nitro patch.
ACE inhibitors
reduce mortality rates after MI.
Administer ACE inhibitors as soon as possible
ACE inhibitors have the greatest benefit in
patients with ventricular dysfunction.
Continue ACE inhibitors indefinitely after MI.
Angiotensin-receptor blockers may be used as
an alternative
adverse effects, such as a persistent cough,
Aspirin and/or antiplatelet
therapy
cardiogenic shock
streptokinase, urokinase, and alteplase (recombinant
tissue plasminogen activator, rtPA), reteplase,
tenecteplase
Surgical Care
Percutaneous Transluminal Coronary Angioplasty
-treatment of choice
PCI provides greater coronary patency
lower risk of bleeding
and instant knowledge about the extent of the
underlying disease.
A specially designed balloon – tipped catheter is
inserted uder flouroscopic guidance and advance
to the site of the obstruction.
Intravascular Stenting
Biologic Stent is produced through
coagulation of collagen, ellastin and
other tissues in the vessel wall by laser,
photocoagulation or radio frequency.
It is done to prevent restenosis after
Percutaneous Transluminal Coronary
Angioplasty.
Emergent or urgent
coronary artery graft
bypass surgery (CABG)
is indicated
angioplasty fails
Severe narrowing of 1
or more coronary
artery.
Commonly used:
Saphenous vein and
internal mamary artery.
Complications
Inflammation
Mechanical
Electrical abnormalities
Cardiac Rehabilitation
A process which a person restored to health
and maintains optimal physiologic,
psychosocial and recreational functions.
Begins with the moment a client is admitted
to the hospital for emergency care, it
continues for months and even years after
the client is discharged from the health care
facility.
Goals of Rehabilitation:
1.To live as full, vital and productive life as
possible.
2.Remain within the limits of the hearth’s
ability to respond to activity and stress.
Activities:
Exercise may gradually implemented
from the hospital onwards.
Exercise session is terminated if any
one of the following occurs: cyanosis,
cold sweats, faintness, extreme fatigue,
severe dyspnea, pallor, chest pain, PR
more than 100/ min., dysrhythmias
greater than 160/95mmHg.
Teaching and Counseling
Self management education guide.
Control hypertension with continued medical
supervision.
Diet
Weight reduction program
Progressive exercise
Stress management techniques
Resumption of sexual activity after 4-6 weeks
from discharge, if appropriate.
Teaching guide on resumption of sexual
activities:
Assume less fatiguing position.
The non- MI partner take the active role
Take nitroglycerine before sexual activity
If dyspnea, chest pain or palpitations
occur, moderation should be observed; if
symptom persist stop sexual activity.
Develop other means of sexual expression.
"You can not do all the good
the world needs, but the
world needs all the good you
can do."
Thank You!