Nursing Myocardia Infarction

8/13/2019 Nursing Myocardia Infarction

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Nursing Care of Patients withCardiovascular and CirculatoryDisorders


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Coronary Artery Disease

Atherosclerosis is an abnormal accumulation oflipids and fibrous tissues in the vessel wall.The atheromas (plaque) protrude into the lumenof the vessel, narrowing it and obstructing bloodflow.The thrombus may obstruct blood flow leadingto myocardial infarction or sudden death.


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Risk Factors:

1. Modifiable risk factors:- Cholesterol levels- Cigarette smoking- Hypertension- Diabetes mellitus

2. Nonmodifiable risk factors: - Age- Gender- Family history- Race


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Myocardial Infarction

Myocardial cells are permanently destroyedCaused by reduced blood flow in coronary artery due toembolus or thrombus

Pharmacologic Therapy:- Thrombolytic- Analgesics- ACE inhibitors

Emergency percutaneous transluminal coronaryangioplasty


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Signs/Symptoms:

1. Chest pain, substernally with radiation to arm, neck, jaw, or back; and unrelieved by rest or nitrates.

2. Diaphoresis and cool, clammy, pale skin.

3. Nausea and vomiting.4. Dyspnea.5. Palpitations or syncope.6. Restlessness and anxiety.

7. Tachycardia or bradycardia.8. Decreased.


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Right-Sided Heart Failure

Signs/Symptoms:1. Dependent pitting edema.

2. Jugular vein distention.3. Hepatomegaly.4. Ascites.5. Weakness, anorexia, and nausea.6. Weight gain.


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Nursing Management:

1. Administer prescribed medications, diuretics, digitalis,anticoagulants, vasodilators.

2. Check intake and output.3. Weigh daily.4. Provide a low- sodium diet.5. Auscultate lung sounds.6. Determine degree of JVD.7. Assess dependent edema.

8. Monitor vital signs.9. Administer oxygen as prescribed.10 Psychological support.


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Peripheral Arterial Occlusive Disease

Is a form of arteriosclerosis involving occlusion ofarteries, most commonly in the lower extremities. Itmay be acute or chronic.Etiology:

1. Acute occlusion may result from trauma, thrombosisor embolism.

2. Chronic occlusion may be caused by:a. Atherosclerosis.

b. Inflammation.c. Thrombosis.d. Trauma.


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1. Resting pain.2. Paresthesia.3. Intermittent claudication.4. Paralysis.

5. Changes in skin and nails such as pale and cold dry skin;and decreased or absent hair growth; brittle andthickened nails.

6. Pulsenesness.

Sign/Symptoms:


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1. Administer prescribed medications, such as vasodilators,anticoagulant, antilipemic, thrombolytic and antiplatelets.

2. Provide proper positioning as prescribed by the physician.3. Instruct the patient to avoid wear elastic socks.4. Teach the patient about the vasoconstrictive effect of

nicotine and caffeine, emotional stress, and teach skin footcare.

5. Provide care for undergoing surgical procedure.

Nursing Management:


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Venous Thrombus

Types of Venous Thrombus:1. Phlebitis is an inflammation in the wall of a vein.2. Superficial thrombophlebitis is a condition in which a

clot forms in a a vein secondary to phlebitis orbecause of partial obstruction of the vein.

3. Phlebothrombosis is the formation of a thrombus orthrombi in a vein.

4. Deep vein thrombosis (DVT) is thrombosis of deeprather than superficial veins.


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High Risk Factors:

1. Hypercoagulability associated with malignant diseaseblood dyscrasias.

2. Venous stasis-following operations, pregnancy, or bedrest for any prolonged illness.

3. Obesity, smoking, DM.

Signs/Symptoms:1. DVT characterized by calf pain, fever, chills, malaise

and swelling and cyanosis of affected leg.2. Superficial thrombophlebitis characterized by visible

and palpable signs, such as heat, pain, swelling,tenderness along the length of the affected vein.


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Nursing Management:

1. Administer prescribed medications, anticoagulant,

thrombolytic and analgesic therapy.2. Provide bed rest with elevating legs to promote venous

drainage reduce swelling.3. Apply dry or moist warm compresses to promote

circulation and reduce pain.4. Instruct patient to wear elastic stocking, avoid sitting or

standing for long period of time, and crossing legs.5. Measure the calf circumference of the affected leg daily.

6. Encourage frequent changes of position.7. Observe skin changes of lower limbs.


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Varicose Vein

Bilateral dilatation and elongation of saphenous veins;deeper veins are normal.

Predisposing Factors:1. Hereditary weakness of vein wall or valves.2. Prolonged standing.3. pregnancy.4. Obesity.

5. Advanced age- loss of vein wall elasticity.


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Signs/Symptoms:

1. Dilated, twisting, discolored vein of the legs.2. Easy leg fatigue, cramps in leg, heavy feeling, increased,

pain during menstruation, nocturnal muscle cramps.Nursing Management:1. Administer analgesics as prescribed.2. Maintain elastic stockings.3. Elevate legs. 4. Instruct the patient to avoid prolonged standing, sitting

or crossing legs to prevent obstruction.5.Discuss the importance of losing weight if the patient is

obese.6.Provide care for undergoing surgical procedure.


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HypertensionHypertension is intermittent or sustained elevation insystolic or diastolic blood pressure.

There are two major types, primary (essential)hypertension and secondary hypertension. More than90% of these cases are primary, and about 10% aresecondary.Etiology:1. Primary hypertension.

a. Non modifiable risk factors.

- Family history.- Gender. Men women.- Age.- Race.


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b. Modifiable risk factors.- Stress.- Obesity.- High dietary intake of sodium or saturated fats.- Excessive caffeine, alcohol, or cigarette smoking. - Oral contraceptives use.

2. Secondary hypertension .- Renal vascular diseases.- Coarctation of aorta.- Primary hyperaldosteronism.- Hyperthyroidism.- Medications, such as estrogen, antidepressants,

NSAIDs, steroids.


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Signs/Symptoms:

1.Usually asymptomatic.2. May cause headache, dizziness, blurred vision.

Nursing Management :1. Administer medications as prescribed, such as diuretics,

antihypertensiveetc 2. Provide patient and family teaching.

- Advise the patient to reduce weight.- Instruct the patient to restrict sodium alcohol and

caffeine intake.


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- Smoking cessation.- Discuss the importance of regular blood pressure

monitoring.- Discuss the importance of lifelong medical follow up

examination.

Nursing Myocardia Infarction

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