...Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Topic: Cardiac – Coronary Artery Disease/Acute Myocardial Infarction 1 Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Table of Contents Introduction...................................................................................................................3 Patient’s profile..............................................................................................................4 Pathophysiology...............................................................................................................................5 Clinical manifestations...................................................................................................................6 Short of breath and ‘light headed’...................................................................................................6 Nauseous and uncomfortable feeling...............................................................................................6 Crushing substernal chest pain .......................................................................................................6 Modifiable and Non-modifiable risk factors.................................................................7 Laboratory tests results and ECG findings................................................................................7 ECG (Electrocardiogram)....................................................................
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...Myocardial Infarction Mortality 1.0 Introduction In the UK, about 838,000 men and 394,000 women have had a myocardial infarction (MI) at some point in their lives, (NICE clinical guideline 48, 2007). The latest statistics from the British Heart Foundation state that approximately 227,000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess...
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...is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include: Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC. On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T. 1 Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A On admission to Accident and Emergency (A&E), Peter will be assessed using the Manchester Triage system (Cooke and Jinks 1999) incorporating the ABCDE approach as per the Resuscitation Council (UK) (2011). The ABCDE assessment and management tool can be applied to all deteriorating or critically ill patients. It is recognized that approximately 30 per cent of people developing a myocardial infarction die before reaching hospital...
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...ACSC41 23/10/03 5:42 PM Page 88 41 Pathophysiology of acute myocardial infarction Start here Macrophages and T-lymphocytes Stunned myocardium Fibrous cap 24 h Lipid core Plaque rupture, platelet aggregation Mainly dead myocytes and neutrophils Transmural necrosed zone Infarct appears pale, most cells dead, neutrophils present— coagulation necrosis Granulation tissue moves inward and replaces dead tissue with scar tissue 2h 5–7 days Subendocardial necrosed zone Cellular damage progressing, but still partially reversible with reperfusion Thrombus propagates into and along coronary artery Endocardium Cross-section of ventricular wall served by thrombosed artery Scar thin firm grey Mixture of living and dead myocytes; substrate for re-entrant arrhythmias 0h > 3 months Finish here 41.1 Infarction is tissue death caused by ischaemia. Acute myocardial infarction (MI) occurs when localized myocardial ischaemia causes the development of a defined region of necrosis. MI is most often caused by rupture of an atherosclerotic lesion in a coronary artery. This causes the formation of a thrombus that plugs the artery, stopping it from supplying blood to the region of the heart that it supplies. Role of thrombosis in MI Pivotal studies by DeWood and colleagues showed that coronary thrombosis is the critical event resulting in MI. Of patients presenting within 4 h of symptom onset with ECG evidence of transmural...
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...Chronic Angina Case Study Advanced Pathophysiology 2/2/14 1) Basis for diagnosis: Six month history of intermittent chest discomfort, described as lower substernal tightness with numbness of the left upper arm, only during exertion. + exercise stress test with pain and 1.5mm of ST segment depression. Class of Angina: Class 1 Chronic angina is associated with a fixed or stable coronary obstruction that creates a disparity between coronary blood flow and the metabolic demands of the myocardium. It is usually precipitated by situations that increase the metabolic needs of the heart such as physical exertion, cold, and emotional stress and relieved within minutes by rest or nitroglycerin. These symptoms occur repeatedly over time, sometimes months to years. This fixed or stable plaque is commonly associated with chronic angina whereas the unstable plaque is associated with unstable angina and myocardial infarction. It is these unstable plaques that are most prone to abrupt plaque changes, followed by thrombosis, that lead to MI, stroke, and sudden cardiac death. These unstable plaques can be divided into three categories of Acute Coronary Syndrome: Unstable Angina, NSTEMI, and STEMI. The pathophysiology between UA and NSTEMI are similar and include these key features: development of an unstable plaque that ruptures or plaque erosion with superimposed non occlusive thrombosis, an obstruction by spasm, constriction, dysfunction, or adrenergic stimuli, severe narrowing...
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...------------------------------------------------- Hypertensive emergency From Wikipedia, the free encyclopedia A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be substantially lowered over minutes to hours with an antihypertensive agent. Contents [hide] * 1 Treatment * 2 Incidence * 3 Definition * 3.1 Hypertensive emergency as a generic term * 4 Pathophysiology * 5 Mortality * 6 Clinical history * 7 References * 8 See also | ------------------------------------------------- [edit]Treatment Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensiveeffect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used. It is also important that the blood pressure is lowered not too...
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...The aim of this essay is to explore an acute deterioration in the health of an adult I have encountered during a clinical placement, in an acute care setting. The essay will begin with a definition of acute care, followed by the introduction of my patient and predisposing factors. This essay will include an explanation of the significant pathophysiological changes and related clinical manifestations and a critical analysis of the nursing interventions implemented during the acute episode of care, focusing on holistic care, rationale and evidence base. It will then describe the actual deterioration in the patient’s condition, and discuss the nurse’s role in the recognition and assessment of the actual deteriorating condition following the trusts policies. Assessment tools, monitoring, detecting and reporting will be considered. Finally this essay will include a discussion of the importance of multidisciplinary team collaboration in the diagnosis and provision of care during the acute episode, and a discussion on whether the deterioration could have been prevented by identifying any areas of practice which could change in relation to evidence based practice. For the purposes of privacy and confidentiality, in accordance with NMC (2008) code of conduct, the name of the patient will be changed to Peter and the placement area will remain as an acute care setting. According to McFerran (2008) the term “acute” is described as a disease of rapid onset, severe symptoms, and brief duration...
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...failure readmissions has increased over the last decades, distinctly related to the aging population and surpassed recovery after a myocardial infarction. Based on the Centers for Medicare and Medicaid Services (CMS) 2005 data, heart failure is the most frequent diagnosis among Medicare beneficiaries and the third highest reimbursement for hospitals (AHRQ, 2013). In 2009, CMS started the public reporting of readmission rates after being discharge for heart failure, and, the year after, the Patient Protection and Affordable Act inaugurated financial penalties for healthcare establishments with most rates of readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk factors are increased for an individual with hypertension, diabetes, coronary heart disease, congenital heart disease, and cardiomyopathy. Unhealthy behaviors can also be contributing factor as well for heart failure such as smoking, use of illegal drugs, and consumption of food high in sodium and cholesterol. II. Pathophysiology Heart failure (HF) is when the heart cannot pump out enough...
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...Case Study: Coronary Disease Laura Kwan Past Medical History: - tonsils removed as a child - no regular medication - takes reloads occasionally Family Medical History: - father died of myocardial infarction at age 52 - mother is 73 and in good health Social History: - moderately heavy social drinker - 2-3 beers after work - 5-6 beers per day on weekends - smokes a pack of cigarettes a day - married with two children - finances are stable History of Present Illness: - woke up at 4am with pressure in his chest, described as “worst indigestion I ever had” - sweaty and slightly short of breath - achy, heavy feeling in his right arm - ate pizza before bed (unhealthy) - took four Rolaids initially - didn't bring any relief - sitting made the pressure settle down - he was clammy - pressure on his chest persistently for approximately two hours - put on oxygen mask - nurses concerned about his EKG - EKG showed 1 cm ST elevation on leads V2,3,4,5 with slight ST depression on leads 2,3 and AVF Physical Examination: - heart rate was 110 (high heart rate) - respiratory rate was 22 (high respiratory rate. Should be 16-20) - blood pressure was 160/100 (high bp) - sweaty, pale, and had no obvious jugular venous distention - chest was clear on auscultation - abdomen was unremarkable - skin was slightly sweaty - chest x-ray was normal with normal heart size - lab work was normal Research: Heart Problems - closely linked to diet and lifestyle choices ...
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...Nursing care plans for Diabetes Mellitus Submitted by lifenurses on Monday, 4 January 2010 2 Comments Nursing care plans for Diabetes Mellitus, Diabetes mellitus is a disorder in which the level of blood glucose is persistently raised above the normal range. Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate. Diabetes mellitus occurs in two primary forms: type 1, characterized by absolute insufficiency, and the more prevalent type 2, characterized by insulin resistance with varying degrees of insulin secretory defects. Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both (ADA], Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2003. Causes for Diabetes Mellitus The cause of both type 1 and type 2 diabetes remains unknown, although genetic factors may play a role. Diabetes mellitus results from insulin deficiency or resistance. Insulin transports glucose into the cell for use as energy and storage as glycogen. It also stimulates protein synthesis and free fatty acid storage. Insulin deficiency or resistance compromises the body tissues’ access to essential nutrients for fuel and storage. The resulting hyperglycemia can damage many of the...
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...COURSE INFORMATION | IG NUMBER | | COURSE | NUTRITION THERAPY II | TOPIC: | NUTRITIONAL MANAGEMENT OF CARDIO-VASCULAR DISEASES | TERM | Prelim | WEEK NO | 2 | SESSION | 2 | DURATION | 5 hrs. | INTENDED LEARNINGOUTCOMES | COURSE OUTCOMES | 1. Explain the pathophysiology, the effects of the disease on patient’s nutritional status and the and the required dietary management. 2. Discuss the principles involved in the dietary management of a patient’s disease. 3. Design a nutritional therapy program for patient with cardio-vascular disease. | UNIT OUTCOME/S | 1. Discussion on cardio-vascular diseases and their nutritional therapy management. 2. Develop nutritional therapy program for a patient with cardio-vascular disease. | MATERIALS AND RESOURCES NEEDED | MATERIALS | * Overhead Projector/Laptop and LCD, Laboratory Manual in Nutrition Therapy | TEXTBOOK | Ruiz, Adela J. (2010). Basic Diet Therapy for Filipinos | SUBTOPICS | * TEACHING ACTIVITY | * LEARNING ACTIVITY | * TIME | * OLFU VMV * PEO, CEO * Course Outline | Interactive Lecture | Interactive Discussion | 1.5 hrs. | * OLFU VMV * PEO, CEO * Course Outline | Problem-solving: Organization of laboratory activities | Laboratory Activity: Class organization and Kitchen brigade system | 2.5 hrs. | SUBTOPICS | * ASSESSMENT TASKS | * ASSESSMENT TOOLS | * TIME | * OLFU VMV * PEO, CEO * Course Outline | * Objective test | * *...
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...According to the American nurses Association, “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (American Nurse Association 2014). Individuals who pursue a nursing career have many responsibilities, for nursing is not just a compassionate profession, but a profession that entails one to be a critical thinker with imperative knowledge in order to effectively care for individuals. Associate Degree Nursing and Bachelor degree nursing are both degrees in which help individuals who pursue a career in nursing, to gain the knowledge and critical thinking to become an effective nurse. Although the associate degree and bachelor degree produce different competencies of nursing from one another, a nurse with higher education possess qualities to provide higher level of care. Associate Degree Nursing Associate degree nursing is a two year technical academic program, developed due to a nursing shortage by Mildred Montag in 1952, that combines general education of nursing and clinical ( Creasier & Friberg, 2011, p. 27). Registered Nurses at an associate degree level are able to function adequately in the intermediate level with the amount of time they are taught in their clinical setting (Masters 1989, pg. 391). The general education of nursing provided in an Associate...
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...About Anaphylaxis Anaphylaxis can be defined as a life threatening and sometimes fatal allergic reaction. It is an allergic reaction that involves several organ systems simultaneously. When you are experiencing this severe reaction, symptoms will manifest in the lungs, skin, throat, nose, or gastrointestinal tract. This type of allergic episode is sometimes called anaphylactic shock, although you may experience this severe allergic event without going into shock, and this would entail a precipitous drop in blood pressure. Anaphylaxis usually occurs after an individual has been initially exposed to an allergen. After that first exposure, the person becomes highly sensitized to that particular allergen. When they are exposed once again, a dangerous allergic reaction will occur and this usually happens within minutes. There are numerous allergens that may cause a person to experience anaphylaxis. These can include: insect bites, drugs such as vaccinations, foods like peanuts or shellfish, or chemicals like latex. Note that peanuts and tree nuts alone are responsible for about 80 percent of all fatal reactions. In some cases, physical exertion has shown to be a contributing factor in this condition. Symptoms There are many different symptoms that one can exhibit during an experiencing anaphylactic episode. Some of these would include: difficulty breathing, dizziness, coughing, hives, stomach pain, cramping, anxiety, confusion, diarrhea, nausea, vomiting, wheezing, a blocked...
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...diagnoses allows reaching a clinical diagnosis. Woo and Robinson (2016), emphasizes completion of full comprehensive assessment coincide to pain etiology, pathophysiology, related comorbid conditions, activity level, and quality of daily life impact with pain experienced (p. 1352). I have been taught early in nursing, “pain perception from a patient is always whatever the patient says”. Establishing what pain is to a patient, to then developing realistic pain control goals set from patient expectations to achieving patient compliance. Commonly, goals to remove chronic pain entirely is not realistic. Suggestive, patient support involves providing patient education to achieve improvement in quality life...
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...definitions of Atrophy, hypertrophy, hyperplasia, hypoplasia, dysplasia, and metaplasia. Week 2 Pain Throughout Organ Systems General anatomy of kidneys, appendix, gallbladder, pancreas, spleen, male and female reproductive organs. Costochondritis vs Angina Pectoris vs Myocardial Infarctions. Rheumatoid arthritis Gout lab findings Week 3 Fluid Balance and Edema Electrolyte imbalances of sodium, potassium, calcium, and magnesium. Intra and Extra cellular concentrations of sodium and potassium as related to osmotic balance. Know the physical signs/symptoms of electrolyte imbalances including hyper and hypo natremia, kalemia, and calcemia. SIADH lab and imaging findings Diabetes insipidus lab and imaging findings Week 4 Topic 4 Acidosis and Alkalosis Know your acid-bases! Week 5 Topic 5 Cardiovascular Causes of Fatigue Cor-pulmonale, cardiomyopathies Week 6 Topic 6 Thyroid, Adrenal, Liver Fatigue Hashimoto’s thyroiditis vs. DeQuervain vs. nodular goiter vs. secondary hypothyroidism Cirrhosis, Addison disease lab tests and hormone responsible. Is it high or low? Week 7 Topic 7 Bleeding as Indicator of Disease Pathophysiology of Disseminated Intravascular Coagulation Pathophysiology of Hemophilia Ulcers Week 8 Topic 8 Fever and Chills Beta-hemolytic streptococcus and Rheumatic fever signs/symptoms and lab findings (and Infective Endocarditis). Acute lymphocytic leukemia, Acute myelogenous leukemia, Chronic myelogenous leukemia, Hodgkin lymphoma...
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