2myocardial Infarction

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MYOCARDIAL

INFARCTION

LEARNING OBJECTIVES

� At the end of the day the discussion, the

students will be able to:

a. Identify myocardial infarction

b. Understand the etiology of MIc. Describe the sign and symptoms of MI

d. Comprehend various nursing

interventions and its stages.

e. Explain nursing managementf. List the medications use for MI

g. Discuss nursing process

h. Know the complications of MI

DEFINITION� Process by which myocardium tissue is

destroyed due to reduced coronary blood

flow and lack of oxygen; actual necrosis of

heart muscle occurs.

ETIOLOGY

1. Insufficient myocardial blood supply is

associated with

a. Atherosclerosis

b. Arteriosclerosisc. Vasospasm

d. Myocardial hypertrophy

e. Severe anemias

f. Respiratory disease (oxygen deficit)

g. Hyperthyroidism (increase force of

contractions)

MANIFESTATIONS

A. CHEST PAIN

1. Heavy (viselike, crushing,

squeezing) chest pain that

may radiate down left arm,hand, jaw and neck.

2. Not relieved by rest often

lasts longer than 15

minutes.

3. Women have a slightly

different presentation:

back pain, indigestion with

nausea, cold sweating,

weakness, pallor.

B. Nausea, vomiting due to stress

reaction

C. Diaphoresis, dizziness due tosympathetic reaction

D. Drop in blood pressure

E. ECG changes: inverted T wave

and depressed ST segmentindicate ischemic changes,

elevated S segment and

widened QRS indicate infarction

F. Denial/anxietyG. Increased Troponin I and T,

MB-CPK, LDH isoenzymes:

done in serials of three to see

trends.

NORMAL ECG

NURSING

INTERVENTIONS

a. EARLY STAGE

1. Treat dysrhythmia properly:

antiarrhythmics such as lidocaine

(xylocaine)

2. Give analgesics: morphine

3. Maintain bed rest: Semi-Fowler¶s position

to decrease venous return and rest

myocardium.

4. Administer oxygen via cannula

5. Monitor vital signs

6. Administer aspirin and heparin to

decrease thrombosis.

7. Administer propr anolol HCL (Inderal):

decreases heart rate and decreases work

of myocardium.

8. Administer calcium channel blockers:

decrease after load: vasodilators:

increases oxygen to myocardium;

decreases preload and after load

9. Provide emotional support

10.Administer streptokinase (kabikinase) or

TPA (³clot busters´): if client arrives

within first 6 hours; major side effect is

bleeding.

1. Administer stool softeners to decrease

myocardial workload.

2. Provide low-fat, low cholesterol, low-

sodium diet, soft food.3. Utilize bedside commode: cause less

energy expenditure than using a bedpan.

4. Promote self -care to tolerance; stop at the

onset of pain.

5. Plan for cardiac rehabilitation

a. Exercise program: stop if fatigue or chestpain occurs

b. Stress management

c. Teach modifiable risk factors reduction

1. Obesity2. Stress

3. Diet

4. Hypertension

5. Smoking6. Lack of exercise

d. Recognize non modifiable risk factors

� Heredity

� Race

� Age

� Sex

� Type ³A´ personality

e. Psychological support

f. Long-term drug therapy

1. Antiarrhythmics: quinidine

2. Anticoagulants: heparin, aspirin,

warf arin (Coumadin), enoxaparin

(Lovenox)

3. Antihypertensives: propr anolol (I nderal),

chlorothiazide (Diuril), and calcium

channel blocker s

4. Vasodilators ± nitroglycerin (nitro-bid)calcium channel blockers.

ASPIRIN

� known as acetylsalicylic acid

� analgesic to relieve minor aches and

pains,

� antipyretic to reduce fever,� anti-

� to help prevent heart attacks, strokes, and

blood clot formation in people at high risk

for developing blood clots. inflammatorymedication.

NURSING MANAGEMENT

� Pain management

Morphine 5-10 mg

� Other medication- nitroglycerin, antiplatelet

& thrombolytic� Keep patient CRIB

� Monitor urine output.

� Relieve nausea and vomiting ² Stemetil

12.5 mg I/V� Soft diet

� Avoid constipation ± give laxative

� Encourage light activities

HEPARIN

� an anticoagulant (blood thinner) that

prevents the formation of blood clots. It

works by blocking reactions in the bodythat lead to blood clots.

� Do not use this medication if you are

allergic to heparin, or if you have:

a. a severe lack of platelets in your blood; or

b. uncontrolled bleeding.

Calcium channel blockers

� prevent calcium from entering cells of the heart

and blood vessel walls, resulting in lower blood

pressure. Calcium channel blockers, also called

calcium antagonists, relax and widen blood

vessels by affecting the muscle cells in the

arterial walls.� Examples of calcium channel blockers include:

1. Amlodipine (Norvasc)

2. Diltiazem (Cardizem LA, Dilacor XR, Tiazac)

3. Felodipine (Plendil)

4. Isradipine (DynaCirc CR)5. Nicardipine (Cardene, Cardene SR)

6. Nifedipine (Procardia, Procardia XL, Adalat CC)

7. Nisoldipine (Sular)

8. Verapamil (Calan Verelan, Covera-HS)

THROMBOSIS

� is the formation of a blood

clot inside a blood vessel,

obstructing the flow of

blood through the

circulatory system.

NURSING DIAGNOSIS

� Pain: chest pain/discomfort related to decreasedcoronary blood supply

� Risk for decreased cardiac output

� Activity intolerance R/T fatigue/ shortness of breath

� Fear/Anxiety R/T hospitalization

� Knowledge deficit regarding disease condition &treatment

Nur sing process

1 Chest pain related to reduced coronary

blood flow.

� Observe or monitor signs and symptoms

associated with pain, such as BP, heart rate,temperature, color and moisture of skin,

restlessness, and ability to focus.

� Assess and record chest pain ± location,

type, severity, aggravation/alleviation

factors, duration, onset.

CONT«

� Obtain 12 lead ECG on admission & each timechest pain recurs

� Give pain relief medication

� Administer nitrates� Inform physician about the pain & record

patient·s response to medication. Give

oxygen ther apy as ordered.

� CRIB RIB gradually increasethe level of physical activities as tolerated.

� Plan activities according to patient¶s

tolerance. Allow rest during and between

activities.� Discuss with patient about alternative

therapy to relief pain such as music therapy,

meditation.

� Educate patient on chest pain: To report anychest pain to the nurse.

2 Risk for decreased cardiac output� Assess pt level of consciousness/mental

alertness

� Monitor vital sign-look for sign of hypotension

� Monitor urine output

� Monitor for pallor, sweating, cyanosis-sign of

peripheral hypo perfusion

� Assess the effect of medication

� Monitor ABG

� Assess and record patient·s level of tolerance toactivities of daily living.

� Encourage patient to verbalize activities thatincrease fatigue or shortness of breath.

� Provide rest period between and during activities� Keep frequently used items within reach of

patient.� Give encouragement and promotes independence

in activities within patient·s limit.� Assist patient in activities of daily living.

3 Activity intolerance related tofatigue / shortness of breath

� Stress management

� Avoid strenuous activity, but canencourage mild exercises

� Advise patient on sign and symptom of

recurrent MI� Advise on medication and its side effect

Health education� Reduce weight

� Low salt, cholesterol diet, avoid heavymeal

� Stop smoking

� Avoid alcohol

ANGINA

PECTORIS

OBJECTIVES

At the end of this the students will be able to

a. Define angina pectoris

b. Understand the causes of angina pectoris

c. Explain the precipitating caused. Knowledgeable on the patterns of angina

e. Know the sign and symptoms of angina

pectoris

f. Understand the different diagnosticprocedure for angina pectoris

g. Explain the rational on nursing

interventions

� Is a chest pain resulting from

myocardial ischemia caused by

inadequate myocardial blood and

oxygen supply.

� Caused by an imbalance

between oxygen supply anddemand.

� Causes include:

a. Obstruction of coronary blood

flow because of atherosclerosisb. Coronary artery spasm

c. Conditions increasing myocardial

oxygen consumption

ANGINA PECTORIS

1. ATHEROSCLEROSIS

� Atherosclerosis (ath-er -o-skler -O-

sis) is a disease in which plaque

(plak) builds up inside your

arteries.

� Fatty deposits, called "Atheromas"

or plaques, damage the lining of

arteries causing them to narrowand harden.

� Plaque is made up of fat, cholesterol, calcium,

and other substances found in the blood.

� Plaque hardens and narrows your arteries,

limiting the flow of oxygen-rich blood to your

organs and other parts of your body. This can

lead to serious problems, including heart attack,stroke, or even death

2. CORONARY SPASM

Chest pain

Increased oxygen demand

Increased Blood pressure

Vasoconstriction

Exposure to cold

ETIOLOGY

Increasedphysicalexertion

Oxygendemand

Chest pain

� To provide relief of an acute attack.

� Correct the imbalance between myocardial

oxygen supply and demand

� Prevent progression of the disease and

further attacks to reduce the risk of MI.

Goal of treatment:

PRECIPITATION FACTORS

CAUSE ANGINA

1. Running upstairs,

2. Getting angry

3. Respiratory infection with fever

4. Exposure to cold weather or eating alarge meal.

1. STABLE ANGINA

a. Also called exertional angina.b. Occurs with activities that involve exertion

or emotional stress and is relieved with

rest or nitroglycerin.

c. Usually has a stable pattern of onset,

duration, severity and relieving factors.

2. UNSTABLE ANGINA

a. Also called preinf arction angina.

b. Occurs with an unpredictable degree of

exertion or emotion and increases in

occurrence, duration, and severity over

c. Pain may not be relieved by

rest/nitroglycerin.

3. VARIANT

ANGINA

a. Also called

PRINZMETAL¶S or

vasospastic angina.

b. Chest pain at rest with

ECG changes due to

coronary artery spasm

c. Attacks may be

associated with ST

segment elevation notedon the

electrocardiogram.

ASSESSMENT

1. PAIN

a. Pain can develop slowly or

quickly.

b. Pain usually is described as

mild or moderate.

c. Substernal, crushing,

squeezing pain may occur.d. Pain may radiate to the

shoulders, arms, jaw, neck and

e. Pain usually last less than 5 minutes, however, pain can last

up to 15-20 minutes.

f. Pain is relieved by nitroglycerin

or rest.

2. Dyspnea

3. Pallor

4. Sweating

5. Palpitations and tachycardia

6. Dizziness and faintness

7. Hypertension

8. Digestive disturbances.

DIAGNOSTIC STUDIES

2. STRESS TEST

� Chest pain or changes in the

electrocardiogram or vital signs

during testing may indicate

ischemia.

� Helps show whether enough

blood flows to your heart when

it's working hard. Doctors

usually use stress testing to

help them diagnose coronaryartery disease (CAD) or to see

how serious this disease is in

those who are known to have it.

3. CARDIAC ENZYMES

AND TROPONINS

� Findings are normal in angina.

� Catheterization provides a

definitive diagnosis by

providing information aboutthe patency of the coronary

arteries.

4. CARDIAC

CATHETERIZATION

NURSING

INTERVENTIONS

A. ASSESS PAIN

1. Location: jaw and or arm as well as chest

2. Character

3. Duration: goes away with rest and/or

nitroglycerine (Nitro-bid)

4. Precipitating factors (once identified,

eliminate or minimize to avoid attacks).

B. Educate the client to help client to adjust

living style to prevent episode of angina

a. Avoid excessive activity in cold weather

b. Avoid overeating

c. Stop smoking

d. Avoid constipation

e. Rest after meals

f. Exercise

g. Decrease stress

C. Teach client that anything that decreases

cardiac output or increases workload of

heart can cause chest pain.

D. Teach client how to cope with an attack:

use of nitroglycerin ± peripheral

vasodilation decreases myocardial

oxygen demand; coronary artery

vasodilation increases supply of oxygen

to myocardium.

NITROGLYCERIN

� Nitroglycerin : vasodilators.

� It works by relaxing the blood vessels so

the heart does not need to work as hard

and therefore does not need as much

oxygen.

� When to take: daily to prevent and/or as

needed at onset of chest pain; if lcient

knows an activity can cause pain, should

take before (e.g. Sexual intercourse).� How often: if at onset of attack, every 5

minutes x 3; if client chest pain still not

relieved call 911

� Stor age: Dark, dry, only good for 3

months.

� Side effects: Headache, hypotension

� Types: tablet, ointment, patch and spray

a. If given daily for prevention, client must be

nitroglycerin free daily for 12 hours to

prevent toleranceb. If patch user: ³on´ upon waking, ³off´ at

bedtime

c. Never take nitroglycerin with out sitting

down and stopping activity.

CONTRAINDICATIONS FOR

NITRATES

� Hypotension

� Increased intr acr anial pressure

� Severe anemia

SIDE EFFECTS OF NITRATES

� Headache

� Orthostatic hypotension

� Dizziness, weakness

� Faintness� Nausea, vomiting

� Flushing or pallor

� Conf usion

� Rash� Dry mouth

� Reflex tachycardia

� Par adoxical br adycardia

CONT....

� Instruct the client to store medications in a

dark, tightly closed bottle

� Instruct the client to check the expiration

date on the medication bottle because

expiration may occur within 6 months of

obtaining medication

� Instruct the client to take acetaminophen

for a headache.

Collater al circulation

� is a network of tiny blood vessels, and,

under normal conditions, not open. When

the coronary arteries narrow to the point

that blood flow to the heart muscle is

limited (coronary artery disease), collateralvessels may enlarge and become active.

This allows blood to flow around the

blocked artery to another artery nearby or

to the same artery past the blockage,protecting the heart tissue from injury.

CONGESTIVE HEART

FAILURE

Definition:

� Congestive heart failure(CHF), or heart failure, is acondition in which the heartcan't pump enough blood to

the body's other organs.� Can be one sided or both

sided failure

ETIOLOGY

A. Narrowed arteries that supply blood tothe heart muscle ² coronary arterydisease

B. Past heart attack, or myocardialinfarction, with scar tissue that interfereswith the heart muscle's normal work

C. High blood pressure

ETIOLOGY

D. Heart valve disease due to pastrheumatic fever or other causes

E. Primary disease of the heart muscle

itself, called cardiomyopathy.

F. Heart defects present at birth ²congenital heart defects.

G. Infection of the heart valves and/or heartmuscle itself ² endocarditis and/or myocarditis

As heart's pumping power is weaker than normal,blood moves through the heart and body at a slower r ate, and pressure in the heart increases.

The chamber s of the heart respond bystretching to hold more blood to pump throughthe body. In time, the heart muscle walls weakenand are unable to pump as strongly.

As a result, the kidneys often respond bycausing the body to retain fluid (water) andsodium thus the body becomes congested.

CCF-PATHOPHYSIOLOGY

When Left ventricle muscle is damaged- itfails to contract/pump with sufficient force

When ventricular fails to circulate blood,

the blood will back up in the lung

Increase pressure in the pulmonarycirculation

Fluid moves into pulmonary tissue andalveoli

PULMONARY EDEMA

LEFT SIDED HEART FAILURE (LVF)

Pulmonary Edema

The most severe manifestation of LeftThe most severe manifestation of Left

Heart FailureHeart Failure

Fluid leak into the pulmonary interstitialFluid leak into the pulmonary interstitial

spaces (Pulmonary congestion/edema)spaces (Pulmonary congestion/edema)

Hypoxia and poor 02 exchangeHypoxia and poor 02 exchange

CLINICAL

MANIFESTATIONS

(LVF)LEFT VENTRICULAR FAILURE

� Dyspnea

� Orthopnea ± difficulty in breathingat rest or when lying flat in bed(supine position causes the fluid toback up in the lung)

� Cough or wheezing

� Frothy pink sputum

� Cr ackles can be heard in thelungs

� Paroxysmal Nocturnal Dyspnea ±waking up at night short of breath.

CLINICAL MANIFESTATIONS

� Cerebral hypoxia- result of decreasedcardiac output causes:

Anxiety

Irritability

Restlessness Confusion

Impaired memory

Insomnia

� Nocturia-

� Oliguria-late manifestation

RIGHT SIDED HEART FAILURE

Edema of the leg, ankles, liver,abdominal cavity

The blood backs up to the tissue, causingcongestion of viscera and peripheral tissue

When Right ventricular fails ,it cannot accept allthe blood returning to the heart

CLINICAL MANIFESTATIONS

Shortness of breath Swelling of feet and ankles

Urinating more frequently at night

Pronounced neck veins

Palpitations (sensation of feeling the heartbeat)

Irregular fast heartbeat

Fatigue

Weakness

Fainting

Hepatomegaly - liver congestion

Ascites ±due to liver congestion

� Jugular venous distention

� S3

� Rales

� Pleural effusion

� Edema

� Hepatomegaly

� Ascites

H t F il Cli i l if t ti

Heart Failure Clinical manifestations :

Pulmonary Congestion (L)

and Systemic Congestion (R)

Right Heart Failure Left Heart Failure

Pulmonary fluid overloadPeripheral fluid overload

A. Serum electrolytes ,urea & nitrogen

B. Liver function test

C. Arterial blood gases ± to evaluate gasexchange

D. Kidney functions testE. Chest X-Ray ± may show pulmonary

vascular congestion, cardiomegaly

F. ECG ± Ventricular enlargement

G. Echocardiography± to evaluate left

ventricular function

CCF- INVESTIGATIONS

CCF-MEDICATIONS

to reduce cardiac work and improve cardiac

function

a. Diuretics

b. Beta blockers.

c. Digitalis ±Digoxin

d. Inotropes-Dopamine, Dobutamine

e. Angiotensin ± converting enzyme

inhibitors

NURSING INTERVENTION FOR

HEART FAILURE

� Assess cardiovascular status, vital sign

and hemodynamic variable to detect signs

of reduced cardiac output.

� Assess respiratory status to detect

increasing fluid in the lungs andrespiratory failure.

� Keep the client in semi-fowler's position to

increase chest expansion and improve

ventilation.

� Administer medication as prescribed, to

enhance cardiac performance and reduce

excess fluids.

� Administer oxygen to enhance arterial

oxygenation.

� Measure and record intake and output,

Intake greater than output may indicated

fluid retention.

� Monitor laboratory test result to detect

electrolyte imbalances, renal failure, and

impaired cardiac circulation.

� Provide suctioning, if necessary assist with

turning and encourage coughing and deepbreathing to prevent pulmonary

complication.

� Restrict oral fluid to avoid worsening the

client's condition.

� Weigh the client daily to detect fluid retention.

A weight gain of 2lb (0,9 kg) in 1 day or 5 lb

(2,3 kg) in 1 week indicates fluid gain.� Measure and record the client's abdominal

girth. An increased in abdominal girth suggests

worsening fluid retention and right-sided heart

failure.� Make sure the client maintains a low-sodium

diet to reduce fluid accumulation.

� Encourage the client to express feelings, such

as a fear of dying to reduce anxiety.

SURGICAL MANAGEMENT

Heart Tr ansplantation

A heart tr ansplant removes a damaged or

diseased heart and replaces it with a healthy

The healthy heart comes from a donor who has

died. It is the last resort for people with heart

f ailure when all other treatments have f ailed.

The most common procedure is to take a

working heart from a recently deceased organ

donor (allogr aft) and implant it into thepatient. The patient's own heart may either be

removed (orthotopic procedure) or, less

commonly, left in to support the donor heart

(heterotopic procedure).

� HEART TRANSPLANTATION

� Heart Transplantation

C di l t

�CardiomyoplastyThis is a procedure in which

skeletal muscles are taken from a

patient's back or abdomen.

Then they're wrapped around an

ailing heart.

This added muscle, aided by

ongoing stimulation from a device

similar to a pacemaker, may boost

the heart's pumping motion.

a. Decreased cardiac output

b. Impaired gas exchange

c. fluid and electrolyte imbalance related

to fluid volume excessd. Imbalanced nutrition: less than body

requirements

e. Risk for impaired tissue integrityf. Activity intolerance

g. Sleep pattern disturbance

h. Fear/Anxiety

NURSING DIAGNOSIS

Assess and record respiratorypattern include rate depth and

rhythm. Observe color of patient ± lips and

nails. Reassure patient during distress

episodes. Put patient in upright position

supported with by pillows-encourage lung expansion.

Breathlessness related to impairedPulmonary gas exchange / impairedgas exchange related to pulmonarycongestion

Promote rest ± reducesoxygen demand.

Administer Oxygen therapy

Give medication as prescribedto reduce pulmonary edema.-Diuretics

Strict intake and output chart

DECREASED CARDIAC

Assess patient for sign of decreased cardiac output-e.g.

confusion, dizziness, irritability

Vital sign ±BP,PR & Spo2monitoring

ECG monitoring-monitor for sign

of dysrhythmiasMonitor lung sound-sign of

crackles & coughing

DECREASED CARDIACOUTPUT

DECREASED CARDIAC

DECREASED CARDIACOUTPUT

Monitor IO -detect sign of reduced

renal perfusion

Medication as prescribed to

increase myocardial contractility- e.gDopamine, Digoxin

Promotes rest to reduce myocardial

workload & oxygen demand

SELF CARE DEFICIT RELATED TO

Assess and record patient¶s level of tolerance to

activities of daily living.

Encourage patient to verbalize activities that

increase fatigue or shortness of breath. Provide rest period between and during

activities

Keep frequently used items within reach of

patient. Give encouragement and promotes

independence in activities within patient¶s limit.

Assist patient in activities of daily living.

SELF CARE DEFICIT RELATED TOFATIGUE / SHORTNESS OF

BREAT H

IMPAIRED SKIN INTEGRITY

Assess and record skin integrity.

Lift correctly to avoid dragging on the

patient¶s skin. Use pressure relieving mattress as necessary.

Encourage patient to move position frequently

If she/ he is unable to do so, assist patient in

changing position every 4 hourly and gentlymassage pressure area to promote bloodcirculation.

IMPAIRED SKIN INTEGRITYRELATED PH YSICALIMMOBILITY.

Impaired skin integrity

Ensure bedclothes are smooth andfree from crumbs.

Change pampers or bed sheet whensoiled.

Keep skin clean and dry at all time.

Impaired skin integrityrelated physicalimmobility.

INADEQUATE NUTRITIONAL

Assess nutritional status.

Record all intake and output chartstrictly.

Observe and record for nausea andvomiting.

Note vomitus for frequency, amount

and color. Refer to dietitian

Advise on dietary supplements

Avoid process and canned food.

QINTAKE RELATED TO LOSS

OF APPETITE

INADEQUATE

Offer small and frequent diet.

Plan meals with patient and dietitian.

Assist patient with meals as needed.

Ensure pleasant environment during

meals. Soft diet as tolerated.

INADEQUATENUTRITIONAL INTAKE

RELATED TO LOSS OFAPPETITE

ANEURYSM

� An aneurysm (AN u rism) is described as a

� An aneurysm (AN-u-rism) is described as a

permanent bulging and stretching of an artery,

in which the dilation is two times or greater the

size of the artery. This balloon-like bulge

abnormality develops a weakness in the arterial

wall and puts the patient at risk for serious

complications.

PATHOPHYSIOLOGY

� Degenerative changes in the muscular

layer of the aorta create a focal weakness,

allowing the inner and outer layer to

stretch outward.

� Blood pressure within the aortaprogressively weakens the vessel walls

and enlarges the aneurysm

Types of aneurysm

1. Aortic aneurysms

2. Cerebral aneurysms

3. Peripheral aneurysms.

The two types of aortic aneurysm area.

a. Thoracic aortic aneurysm (TAA)

b. Abdominal aortic aneurysm (AAA).

Factors that increase the risk for aneurysm

include:

include:1. Atherosclerosis, a buildup of fatty deposits in the arteries.

2. Smoking. People who smoke are eight times more likely to develop ananeurysm.

3. Overweight or obesity: A family history of aortic aneurysm, heart disease,

or other diseases of the arteries.

� Certain diseases that can weaken the wall of the aorta, such as:

a. Marfan syndrome (an inherited disease in which tissues don't developnormally)

b. Untreated syphilis (a very rare cause today)

c. Tuberculosis (also a very rare cause today)

4. Trauma such as a blow to the chest in a car accident.5. Severe and persistent high blood pressure between the ages of 35 and 60.

This increases the risk for a cerebral aneurysm.

6. Use of stimulant drugs such as cocaine.

I. Abdominal Aortic Aneurysms

Abdominal Aortic

Aneurysm

� An abnormal dilation in the arterial

wall, most commonly occurs in the

aorta between the renal arteries

and iliac branches.

1. FUSIFORM: Diffuse dilation that

involves the entire circumferenceof the arterial segment

2. SACCULAR: Distinct localized out

pouching of the artery wall

3. DISSECTING: Created when

blood separates the layers of theartery wall, forming a cavity

between them

4. FALSE (pseudoaneurysm):

a. Pseudoaneurysm occurs when the

clot and connective tissue areoutside the arterial wall

b. Pseudoaneurysm occurs as a

result of vessel injury or trauma to

all three layers of the arterial wall.

M t bd i l ti (AAA ) d l

Most abdominal aortic aneurysms (AAAs) develop

slowly over years. They often don't have signs

or symptoms unless they rupture. If you have an AAA, your doctor may feel a throbbing mass

while checking your abdomen.

When symptoms are present, they can include:

a. A throbbing feeling in the abdomen

b. Deep penetrating pain in your back or the side

of your abdomen

c. Steady, gnawing pain in your abdomen thatlasts for hours or days

d. Coldness, numbness, or tingling in the feet due

to blocked blood flow in the legs

If an AAA r uptures, symptoms can include

sudden, severe pain in your lower

abdomen and back

a. nausea (feeling sick to your stomach) and

vomiting

b. clammy, sweaty skin; lightheadedness;

c. a rapid heart rate when standing up.

d. Internal bleeding from a ruptured AAA can

send you into shock. This is a life-threatening

situation that requires emergency treatment.

II Th i A ti A

II. Thor acic Aortic Aneurysms

Thoracic aortic aneurysm (TAA) may not

cause symptoms until it dissects or grows

large. Then, symptoms may include:

a.Pain in your jaw, neck, back, or chest

b.Coughing, hoarseness, or trouble breathing

or swallowing.

III Cerebral Aneurysm

III. Cerebr al Aneurysm

If a cerebral (brain) aneurysm presses on

nerves in the brain it can cause signs and

nerves in the brain, it can cause signs and

symptoms. These can include:

A droopy eyelid Double vision or other changes in

vision

Pain above or behind the eye

A dilated pupil

Numbness or weakness on one side of

the face or body

IV Peripheral Aneurysm

IV. Peripher al Aneurysm

Signs and symptoms of peripher al

aneurysm may include:

A pulsating lump that can be felt in the

neck, arm, or leg.

Leg or arm pain, or cramping with exercise

Painful sores on toes or fingers.

Gangrene (tissue death) from severely

blocked blood flow in the limbs.

An aneurysm in the

popliteal artery (behind the

knee) can compress

nerves and cause pain,

weakness, and numbness

in the knee and leg.

DIAGNOSTIC PROCEDURE

1. Abdominal or chest X-rays may show

calcification that outlines the aneurysm.

2. CT scan and ultrasonography are used to

detect and monitor size of aneurysm.

3. MRI or magnetic resonance angiographyfurther evaluate circulation.

4. Arteriography allows visualization

of aneurysm and vessel.

Surgical Interventions:

� Surgery may be required to remove the

aneurysm and restore vascular continuity

with a bypass graft.

� Complications of surgery include arterial

occlusion, graft hemorrhage, infection,ischemic colon, and impotence.

� Endovascular grafting using stent inserted

via catheter through the femoral artery

may be warranted.

NURSING INTERVENTIONS

1. Monitor for signs and symptoms of spinal cord ischemia

such as pain, numbness, paresthesia, and weakness

caused by dissection.

2. Monitor for signs of stroke or cardiac tamponade caused

by dissection.

3. Postoperatively, monitor vital signs continuously.

4. Check extremities for sensation, temperature, pulses,

color, capillary refill, and petechiae.

5. Monitor for bleeding from the wound and for signs of hemorrhage, hypotension, tachycardia, pallor, and

diaphoresis.

6. Monitor temperature and incision for signs of

infection.

7. Monitor urinary output hourly.8. Administer antibiotics, if ordered, to prevent

infection.

9. Administer pain medication, as ordered, or

monitor patient-controlled analgesia.

10.Elevate the head of the bed no more than 45

degrees for first 3 days postoperatively to

prevent pressure on the repair graft site.

7. Warn patient not to cross legs or sit for long

i d t t th b f ti

periods to prevent thrombus formation.

8. Teach the patient about blood pressuremedications and the importance of taking them

as prescribed.

9. Teach the patient to recognize and report signs

and symptoms of an expanding aneurysm or rupture.

10.Encourage adequate nutritional intake to

enhance wound healing.

11.Teach the patient to maintain a

postoperative exercise regimen.

2myocardial Infarction

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