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NURSING OF ADULTS WITH MEDICAL

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Angina Pectoris Etiology ... substernal or retrosternal may radiate Dyspnea Anxiety Apprehension Diaphoresis Nausea Ischemic Myocardial Pain Angina Pectoris Treatment ... – PowerPoint PPT presentation

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Title: NURSING OF ADULTS WITH MEDICAL


1
NURSING OF ADULTS WITH MEDICAL SURGICAL
CONDITIONS
  • Diseases and Disorders
  • of the
  • Heart

2
Angina Pectoris
  • Etiology/Pathophysiology
  • Cardiac muscle is deprived of oxygen
  • Ischemia
  • Increased workload on the heart
  • Exposure to cold
  • Exercise
  • Unusually heavy meals
  • Emotional stress
  • Other strenuous activity

3
Angina Pectoris
  • Signs Symptoms
  • Pain (usually relieved by rest)
  • heaviness or tightness in chest
  • usually substernal or retrosternal
  • may radiate
  • Dyspnea
  • Anxiety
  • Apprehension
  • Diaphoresis
  • Nausea

4
Ischemic Myocardial Pain
5
Angina Pectoris
  • Treatment
  • Correct cardiovascular risk factors
  • Avoid precipitating factors
  • Medications
  • dilate coronary arteries and decrease workload of
    heart
  • Nitroglycerin
  • give SL, repeat q 5 min, up to three times
  • Beta adrenergic blocking agents
  • Inderal, Corgard, Lopressor
  • Calcium channel blockers
  • Procardia, Cardizem, Calan, Isoptin

6
Angina Pectoris
  • Surgical Interventions
  • Coronary Artery Bypass Graft (CABG)
  • Saphenous vein used to bypass occluded arteries
  • Percutaneous Transluminal Coronary Angioplasty
    (PTCA)
  • Cardiac catheterization is done and a balloon
    inflated in narrowed artery
  • Stent Placement
  • Expandable, meshlike structures designed
  • to maintain vessel patency

7
Coronary Artery Bypass Graft
8
PTCA Stent
9
Myocardial Infarction
  • Etiology/Pathophyisiolgy
  • Occlusion of a major coronary artery or one of
    its branches with subsequent necrosis of
    myocardium
  • Most common cause is atherosclerosis
  • Ability of the cardiac muscle to contract and
    pump blood is impaired

10
Common Locations of MI
11
Myocardial Infarction
  • Signs Symptoms
  • Asymptomatic (silent MI)
  • Similar to Angina Pectoris, but are more severe
    and last longer
  • Pain (not relieved by rest, position, or
    nitroglycerine)
  • Nausea
  • SOB
  • Dizziness
  • Weakness
  • Diaphoresis
  • Pallor - ashen color
  • Sense of impending doom

12
Myocardial Infarction
  • Treatment
  • Oxygen
  • Fibrinolytic agents
  • Streptokinase
  • Tissue plasma activator (TPA)
  • Percutaneous Transluminal Coronary Angioplasty
    (PTCA)
  • Coronary Artery Bypass Graft surgery
  • Medications

13
Myocardial Infarction
14
Congestive Heart Failure
  • Etiology/Pathophysiology
  • Abnormal condition characterized by circulatory
    congestion as a result of the hearts inability
    to act as an effective pump.
  • Left ventricular failure
  • Most common
  • Right ventricular failure
  • Usually caused by left ventricular failure

15
Congestive Heart Failure
  • Signs Symptoms
  • Decreased cardiac output
  • fatigue
  • angina
  • anxiety
  • oliguria
  • decreased GI motility
  • pale, cool skin
  • weight gain
  • restlessness

16
Congestive Heart Failure
  • Left Ventricular Failure
  • Pulmonary congestion
  • dyspnea
  • paroxysmal nocturnal dyspnea
  • cough
  • frothy, blood-tinged sputum
  • orthopnea
  • pulmonary crackles
  • pleural effusion (x-ray)

17
Congestive Heart Failure
  • Right Ventricular Failure
  • Distended jugular veins
  • Anorexia, nausea, and abdominal distention
  • Liver enlargement
  • Ascites
  • Edema in feet, ankles, sacrum may progress up
    the legs into thighs, external genitalia, and
    lower trunk

18
Congestive Heart Failure
  • Treatment
  • Increase cardiac efficiency
  • Digitalis
  • Vasodilators
  • nitroglycerin
  • ACE inhibitors (decrease B/P)
  • Capoten, Vasotec, Altace, Lotnesin, Prinivil,
    Zestril, Accupril Monopril
  • Lower oxygen requirements
  • Bedrest, HOB elevated
  • Oxygen

19
Congestive Heart Failure
  • Treat edema and pulmonary congestion
  • diuretics
  • sodium restricted diet
  • restriction of fluids
  • Monitor fluid retention
  • weigh daily
  • strict IO

20
Pulmonary Edema
  • Etiology/Pathophysiology
  • Accumulation of fluid in lung tissues and alveoli
  • Complication of CHF

21
Pulmonary Edema
  • Signs Symptoms
  • Restlessness
  • Agitation
  • Disorientation
  • Diaphoresis
  • Dyspnea Tachypnea
  • Tachycardia
  • Pallor or cyanosis
  • Cough - large amounts of blood-tinged, frothy
    sputum
  • Wheezing, crackles
  • Cold extremities

22
Pulmonary Edema
  • Treatment
  • High Fowlers or Orthop. postion
  • Morphine sulfate
  • Oxygen
  • Nitroglycerin
  • Diuretics
  • Lasix, Bumex
  • Inotropic agents (increase myocard. Contraction
    periph. dilation)
  • Dobutrex, Inocor
  • Vasodilators
  • Nitropress

23
Valvular Heart Disease
  • Etiology/Pathophysiology
  • Heart valves are compromised and do not open and
    close properly
  • Stenosis
  • thickening of the valve tissue, causing the balve
    to become narrow
  • Insufficiency
  • valve is unable to close completely
  • Congenital
  • Rheumatic fever

24
Valvular Heart Disease
  • Signs Symptoms
  • Fatigue
  • Angina
  • Oliguria
  • Pale, cool skin
  • Weight gain
  • Restlessness
  • Abnormal breath sounds
  • Edema

25
Valvular Heart Disease
  • Treatment
  • Restrict activities
  • Sodium restricted diet
  • Diuretics
  • Digoxin
  • Antidysrhythmics
  • Pronestyl, Quinidine, Lidocaine, Norpace
  • Surgery
  • Open mitral commissurotomy
  • splitting of the fused valve
  • Valve replacement
  • valve replaced with a bioprosthetic or mechanical
    valve

26
Rheumatic Heart Disease
  • Etiology/Pathophysiology
  • Rheumatic Fever
  • inflammatory disease which is a delayed childhood
    reaction to inadequately treated childhood upper
    resp. tract infection of Beta hemolytic
    streptococci
  • causes scar tissue in the heart

27
Rheumatic Heart Disease
  • Signs Symptoms
  • Elevated temperature
  • Elevated heart rate
  • Epistaxis
  • Anemia
  • Joint pain and stiffness
  • Nodules on the joints
  • Specific to valve affected
  • Heart murmur

28
Rheumatic Heart Disease
  • Treatment
  • Prevention
  • Treat infections rapidly and completely
  • Penicillin
  • Bedrest
  • NSAIDs
  • Application of heat
  • Well-balanced diet (supplement with Vit. B C)
  • Encourage fluids
  • Commissurotomy or valve replacement

29
Pericarditis
  • Etiology/Pathophysiology
  • Inflammation of the membranous sac surrounding
    the heart
  • May be acute or chronic
  • Bacterial, viral, or fungal
  • Noninfectious conditions
  • azotemia, MI, neoplasms, scleroderma, trauma,
    SLE, radiation, drugs

30
Pericarditis
  • Signs Symptoms
  • Debilitating pain
  • aggravated by lying supine, deep breathing,
    coughing, swallowing and moving the trunk
  • Dyspnea
  • Fever
  • Chills
  • Diaphoresis
  • Leukocytosis
  • Pericardial friction rub
  • Pericardial effusion (x-ray)

31
Pericarditis
  • Treatment
  • Analgesia
  • morphine, Demerol
  • Oxygen
  • IV fluids
  • Salicylates
  • Antibiotics
  • Antiinflammatory agents
  • Indocin
  • Corticosteroids
  • Surgery
  • Pericardial window, pericardial tap

32
Endocarditis
  • Etiology/pathophysiolgy
  • Infection or inflammation of the inner membranous
    lining of the heart
  • Risk factors
  • rheumatic heart disease
  • CHF
  • Degenerative heart disease
  • Invasive procedures
  • mainline drug users

33
Endocarditis
  • Signs Symptoms
  • Influenza-like symptoms
  • Fever
  • Fatigue
  • Chest pain
  • Headaches
  • Joint pain
  • Chills
  • Petechiae in the conjunctiva, mouth, and legs
  • Anemia
  • Splinter hemorrhages under nails
  • Weight loss
  • Heart murmur

34
Endocarditis
  • Treatment
  • Bedrest
  • Antibiotics
  • IV 1-2 months
  • Prophylactic antibiotics for high risk patients
  • Surgical repair of diseased valves or valve
    replacement

35
Myocarditis
  • Etiology/Pathophysiology
  • Inflammation of the myocardium
  • Rheumatic heart disease
  • Viral, bacterial, or fungal infection
  • Endocarditis
  • Pericarditis

36
Myocarditis
  • Signs Symptoms
  • Vary according to site of infection
  • Cardiac enlargement
  • Murmur
  • Gallop
  • Tachycardia

37
Myocarditis
  • Treatment
  • Bedrest
  • Oxygen
  • Antibiotics
  • Antiinflammatory agents
  • Assessment and correction of dysrhythmias

38
Cardiomyopathy
  • Etiology/Pathophysiology
  • A group of heart muscle diseases that primarily
    affects the structural or functional ability of
    the myocardium
  • Not associated with CAD, hypertension, vascular
    disease, or pulmonary disease
  • Primary - unknown cause
  • Secondary - Infective, metabolic, nutritional,
    alcohol, peripartum, drugs, radiation,
    SLE, rheumatoid arthritis

39
Cardiomyopathy
  • Signs Symptoms
  • Angina
  • Syncope
  • Fatigue
  • Dyspnea on exertion
  • Severe exercise intolerance
  • S/S of left and right-sided CHF
  • dyspnea, peripheral edema, ascites, hepatic
    dysfunction

40
Cardiomyopathy
  • Treatment
  • Treat underlying cause
  • Diuretics
  • ACE inhibitors
  • Beta-adrenergic blocking agents
  • Internal defibrillator
  • Cardiac transplant
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