the client with a cardiovascular alteration

8/3/2019 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?


6/15

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.

the client with a cardiovascular alteration

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