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CRISIS
Nina Hamili G. Piao RN
HEMODYNAMICS
The heart, large blood vessels, and the microcirculation (capillary circulation)
interact to keep all body tissues perfused with blood. Effective perfusion
requires good cardiac pumping ability, an adequate amount of blood to be
pumped, and ability of blood vessels to constrict and to dilate to maintain
blood pressure.
Heart rate
Increased by sympathetic and decreased by parasympathetic nervous
system stimulation.
Stroke volume
Volume of blood ejected by the ventricle with each heartbeat.
Normal: 6070 ml.
HEMODYNAMICS
The hearts ability to pump is measured by cardiac output (CO), the amount of blood
pumped per minute.
CO =HR x SV ; SV depends on three factors: preload, afterload, and contractility
Normal: 46 l/min.
Preload is the amount of blood presented to the ventricle just before systole.
Right ventricular preload is measured by CVP (normal range 24 mmHg).
Left ventricular preload volume pressure is measured as the pulmonary artery wedge
pressure (PAWP) (normal
range 512 mmHg).
Afterload refers to the amount of resistance to the ejection of blood from the ventricle.
Contractility, the force of contraction, is related to the status of the myocardium.
(contractile force of the heart or inotropy)
HEMODYNAMICS
Central venous pressure (CVP)
Pressure created by blood volume in the right side of the heart.
Normal: 24 mmHg.
Medications:
-angiotensin-converting enzyme (ACE) inhibitors
-diuretics
-digitalis
Rx
-beta blockers
-nitrates
-antihypertensives
-positive inotropes (dopamine, dobutamine)
-direct vasodilators
-morphine sulfate
Rx
Physical and psychological rest
Oxygen
If medical intervention is unsuccessful then mechanical assist devices (intra-
aortic balloon pump [IABP]
left ventricular assist devices
heart transplant
Nursing Interventions:
Monitor I&O
Check weight daily
Assess for signs of fluid overload
Monitor level of consciousness
Assess VS, heart and lung sounds
Monitor for cardiac dysrhythmias
Maintain bed rest with HOB elevated
Instruct client to avoid valsalva maneuver
Nursing Interventions:
Assess and record abdominal girth
Monitor ABGs
Oxygen as prescribed
Provide emotional rest
Monitor electrolytes
Administer medications as ordered
Provide client teaching
Provide low-sodium diet as ordered
Client teaching for self-care
Client teaching for self-care
Instruct client
to perform activity without adding to fatigue, so he/she should pace and
prioritize daily activities to avoid extremes in temperature that would tax
cardiac function
to stop activity if experiencing lightheadedness or shortness of breath
to plan for periods of rest alternating with periods of activity
Client teaching for self-care
to maintain a low-sodium diet
to take potassium replacement if taking a potassium depleting diuretic and/or
include foods high in potassium in the diet, e.g., orange and tomato juice,
bananas, raisins, figs,prunes, apricots, spinach, cauliflower, and potatoes
to take diuretics at times that allow for uninterrupted sleep
to adhere to medical regime
to weigh self daily and report to physician a greater than 3-lb weight gain
ACUTE MYOCARDIAL INFARCTION
Myocardial infarction (MI) is also known as Acute Coronary Syndrome.
It refers to the chest pain brought on by acute obstruction of coronary blood
flow.
MI occurs suddenly.
It results in imbalance of myocardial oxygen supply and demand.
It causes the death of myocardial cells.
ACUTE MYOCARDIAL INFARCTION
Remember the three Is of the progression of pathophysiology
of an MI: Ischemic tissue progresses to
Injured tissue, which in turn progresses to Infarcted or dead tissue.
ACUTE MYOCARDIAL INFARCTION
Acute substernal pain described as crushing which may radiate to back or jaw
Levines sign (chest hand-clutching). This is the universal sign of distress
in agina pectoris and MI.
- Cessation of blood supply to myocardium due to thrombotic occlusion
causes accumulation of metabolites (e.g. lactic acid) within ischemic part of
myocardium. Lactic acid irritates nerve endings resulting to pain.
S/S:
Feeling of impending doom, restlessness
-Severe pain of a heart attack is terrifying
-Pain lasts more than 20 minutes and is not relieved with rest and/or
nitroglycerine.
Shortness of breath
Shock
-Manifested by SBP <80mmHg, lethargic, cold diaphoresis, peripheral
cyanosis, weak pulse.
-Due to severe pain, severe reduction of C. O. and inadequate tissue
perfusion causing tissue hypoxia
S/Sx.
Oliguria
-Urine flow less than 30 ml/hr. indicates renal hypoxia due to inadequate
tissue perfusion.
Gas pains around the heart, nausea and vomiting
=nausea and vomiting may result from the severe pain or from vasovagal
reflexes conducted from an area of damaged myocardium to GI tract.
S/Sx
Fever-occurs within 24 hours and extens to 3-7 days
-due to destruction of myocardial tissue and inflammatory process
Acute Pulmonary Edema- dyspnea, orthopnea
-LV becomes severely weakened in pumping action due to the infarction
Dx: