the client with a cardiovascular alteration
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THE CLIENT WITH A CARDIOVASCULARALTERATION:
ACUTE MYOCARDIALINFARCTION
BSN IV
Arellano, Liza G.
Carandang, Dana Erica D.
Fideli, Rachelle B.Opulencia, Melarnie G.
Saldua, Ma.Shiela S.
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Myocardial infarction(MI or AMI for acute
myocardial infarction), commonly known as a heart attack,
occurs when the blood supply to part of the heart isinterrupted.
RISK FACTORS:
Hyperlipidemia
Diabetes Mellitus
Hypertension
Tobacco Use
Male GenderFamily History
Two types of heartattacks:
1. Transmuralmyocardial infarction.2. Nontransmuralmyocardial infarction
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TERMINOLOGIES
Hyperlipidemia
CADCPK
PTCA
IABP
MB isoenzyme
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LEARNING ISSUES
1. What are the signs and symptoms of acute myocardialinfarction?
2. What are the risk factors for acute myocardialinfarction?
3. What could be the possible risk factors for the patient toexperience having cardiomegaly?
4. What is the normal value of CPK?
5. What is the relationship of CPK in thepatients condition?
6. Is the value of CPK an indicator that made itclear that the patients prognosis was
extremely grim?7. Among all the procedures done in the patient.
What could be the possible indicator that
could affect the rose of CPK?
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LEARNING ISSUES
8. What is the normal value of troponin I?
9. What is the purpose of troponin I in the patientscondition?
10.What does ST elevation indicates?
11.What is the purpose of PTCA in the patients condition?
12.Why does PTCA failed to re-open theright coronary artery of the patient?
13.Why is a transcutaneous pacemakerplaced in the patient?
14.Why the paramedics did gave atropine tothe patient when they found out he wascool, clammy, bradyardic andhypotensive?
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LEARNING ISSUES
15.Why is the patient experiencing expiratory wheezes but
does not have signs of pulmonary edema?
16.Why did the patient display a decrease in pulseoximeter blood oxygen saturation and cyanosis despitethe addition of supplementary oxygen?
17.Why is there a need for the patient to be intubated?
18.Why is aspirin given to the patient in thecase that he is experiencing hypotension?
19.What is the action of dopamine in thepatients body?
20.What is the purpose of giving morphine tothe patient?
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Atherosclerotic plaque
Builds up in the coronary
artery
Blockage of the coronary
artery
Narrowing of the
coronary arteries
Atheroma
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Blood supply
Ischemia
Myocardial cell death
Aerobic to anaerobic
metabolism
Lactic acid production
Release of
intracellular enzymes
CPK MB
(+)Troponin I
Hypoxia
myocardial contractility
Ventricular function
Altered
repolarization of
myocardium
ST
Segment
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Pain
Changes in acid base
balance
Acidosis
dysrithmias
Cardiomegalybradycardic
Chestpain
SOB
Cardiac output
Blood flow in the brain
Loss of
Consciousness
Coolclammy
Hypotension
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NURSING DIAGNOSIS
Acute painrelated to
inadequate flow
of blood to the
tissue of the
heart as
evidenced by
facial Grimace,
cool and
clammy skin,
hypotension
and a
pain scale of
8/10
Ineffective
cardiac tissue
perfusion
related to
reduced
coronary blood
flow as
evidence by
dyspnea,
bradypnea,
and
hypoxemia
Impaired gasexchangerelated toaltered blood
flow asevidenced bybradypnea,nasal flaring,cool, clammyskin,
restlessnessand hypoxemia.
Decrease
cardiac output
related to
altered
contractility as
evidenced by
cool, clammy
skin, cyanosis
and
hypotension.
Activity
intolerance
related to
imbalance
between
myocardial
oxygen supply
and demand
as evidence
by generalized
weakness,
cyanosis,
hypotension
and inability to
stand and
walk.
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DRUGS
Atropine sulfate
Heparin
Morphine
Aspirin
Dopamine drip
LABORATORY LABORATORY
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ANALYTE RESULT NORMALRANGE
CPK-MB89 IU/L-4422
IU/L 5-100 IU/L
TROPONIN I
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Treated withIABP
AspirinAtropine Morpine
PTCA
Acute MyocardialInfarction
Elavated riskfrom
Cigarettesmoking
Obesity DiabetesMellitus
FamilyHistory
LDLcholesterol
Diagnosedwith:
Electrocardiogram
X-ray
Cardiac Catheterization
Concept Map
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Best Case Scenario
Threat the acuteattack of acutemyocardial infarction
If the treatment worked theprogression of the disease willstabilize.Prevention of further tissue injuryand limitation of infarction size
Worst Case Scenario:
Potential complications
Acute pulmonary edema
Heart failureCardiogenic shockDysrhythmias and cardiac arrestPericardial effusion and cardiactamponade
Myocardial rupture
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THANK YOU!REFERENCES:
Nurses pocket guide, edition11 by Marilyn E. Doenges et.al
Nursing Diagnosis reference manual, 6th edition by Shiela SparksRalph et.al
Nursing care plan guidelines for individualizing patient care, 6
th
edition,Marilyn E. Doenges
Medical-Surgical Nursing, vol.2 by Suzanne C. Smeltzer et.al
Essentials of Pathophysiology, 2nd edition, by Carol Mattson Porth
Fundamentals of Anatomy and Physiology, 2nd editon, by
Gilliam, S. (2006) Springhouse Nurses Drug Guide (7 th Ed.),
Lewis, s. Heithkemper, m. and Dirksen, S. (2007) Medical-SurgicalNursing: Assessment and Management of Clinical Problems (7th Ed.)St. Louis: Mosby. Donald C. Ritzo
Brunner, L, Bare, B., Hinkle, J., Cheever, K. (2010) Brunner andSuddarth Textbook of Medical-Surgical Nursing (12 Ed.), Philadelphia:Lippincott Williams and Wilkins.
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