Stress Obesity
Diet Personality Type or
Exercise Behavioral Factors
Cigarette Smoking Contraceptive Pills
Alcohol
Hypertension
Hyperlipidimia
Diabetes Mellitus
Cardiovascular Assessment
Dyspnea
Subjective feeling (inability to get
enough air).
Dyspnea on exertion is due to increased
O2 myocardial demand.
Orthopnea is related to blood pooling
in the pulmonary bed; suspect
Pulmonary Edema
Any sudden or acute dyspnea may be a
sign of Pulmonary Embolism
Chest tightness
Cardiovascular Assessment
Cough/sputum
Mucoid and foamy sputum can be a sign
of CHF
Pink-tinged frothy appearance may signal
Pulmonary Edema.
Whitish, viral infection
Change in color other than the above
mentioned may signify bacterial infection
Cardiovascular Assessment
Cyanosis
Bluish discoloration of the skin and
mucous membrane
Sat O2 is below 90%
Fatigue
May be due to Anemias or related to
decreased Cardiac Output
Cardiovascular Assessment
Palpitations
Awareness of rapid or irregular heart beat
Autonomic Nervous System and Adrenal
Glands response (stress)
Syncope
Transient loss of consciousness
Due to decreased cerebral
tissue perfusion
Cardiovascular Assessment
Edema
Due to: Increased Hydrostatic Pressure
(HP)
Decreased Colloidal Oncotic Pressure
(COP)
Obstructed Lymphatic or Vascular System
Related to Inflammatory reaction
Types of Edema
Bilateral edema
=CHF or Renal Failure
Unilateral edema
=Vascular or Lymphatic obstruction
Non-pitting edema
=Inflammatory
Pitting edema
=HP and COP derangement
Cardiovascular Assessment
Skin
Color, temperature, hair growth, nails,
capillary refill
spooning of fingers /clubbing of fingers
Cardiovascular Assessment
Hemodynamic Monitoring
Swan-Ganz Catheterization
Right side of the heart
Pulmonary artery pressure
Pulmonary artery occlusive pressure
Right atrial pressure
Cardiac output
Swan-Ganz Catheterization
Laboratory & Diagnostic Test
Coronary Angiogram
allows to visualize narrowings or
obstructions
therapeutic measures can follow
immediately.
Goal of Treatment
Pain relief
Reduction of myocardial oxygen
consumption
Prevention and treatment of complications
Intervention
IV Fluids
D5W to KVO
If unable to take food/fluid per orem
1000ml/8 hours
K supplement
Intervention
Pain Medication
Morphine SO4
(2-5mg/IV dose)
Potent analgesic
Peripheral venous vasodilation
Pulmonary venous distention
Inferior wall MI: may increase vagal
discharge
Intervention
Tranquilizres
To decrease anxiety
Diazepam (5-10 mg per IV/orem)
Laxative
To prevent straining during defecation
Lactulose (HS)
Intervention
Nursing Consideration:
Assess Pulse Rate before administration;
with hold if bradycardia is present.
Administer with food, may cause GI upset.
Do not administer with asthma it causes
Bronchoconstriction.
Do not give to patient with DM, it causes
hypoglycemia.
Antidote for Beta Blocker poisoning is
Glucagon
Intervention
Nitrates
Act by augmenting perfusion at the border
of ischemic zone.
Generalized vasodilation
Reducing myocardial O2 demand
Lowering preload
Lowering afterload
Ex: IV Nitroglycerine,
Sublingual Niotroglycerine,Oral/Transdermal
Nitroglycerine
Intervention
Nursing Considerations:
Only a maximum of 3 doses at 5 min. interval.
Offer sips of water before giving it
sublingually.
Store the medication in a cool, dry place; use
dark /amber container.
If side effects is noticed do not discontinue
the drug this is usual in the first few doses
of medication.
Rotate skin sites for nitro patch.
Intervention
ACE inhibitors
reduce mortality rates after MI.
Administer ACE inhibitors as soon as
possible
ACE inhibitors have the greatest benefit in
patients with ventricular dysfunction.
Continue ACE inhibitors indefinitely after MI.
Angiotensin-receptor blockers may be used
as an alternative
adverse effects, such as a persistent cough,
Intervention
Nursing Considerations:
Assess for signs and symptoms of Bleeding.
Avoid straining at stool to avoid
rectal bleeding.
It should be given with food.
Observe for toxicity- Tinnitus (ringing of ears).
May cause Bronchoconstriction- Observe
for wheezing.
Intervention
Heparin
Assess for S/S of Bleeding.
Keep Protamine Sulfate available.
If used SQ. do not aspirate to prevent
hematoma formation.
Monitor for PTT or APTT
Used for a maximum of 2 weeks.
Intervention
Thombolytic therapy
The effectiveness:
highest in the first 2 hours
After 12 hours, the risk associated with
thrombolytic therapy outweighs any benefit
Intervention
Contraindicated
unstable angina and NSTEMI
and for the treatment of individuals with
evidence of cardiogenic shock
streptokinase,urokinase, and alteplase
(recombinant tissue plasminogen activator ,
rtPA),reteplase,tenecteplase
Drugs
Intervention
Surgical Care
Percutaneous Transluminal Coronary
Angioplasty -treatment of choice
PCI provides greater coronary patency
lower risk of bleeding
and instant knowledge about the extent of the
underlying disease.
A specially designed balloon tipped catheter
is inserted under fluoroscopic guidance and
advance to the site of the obstruction.
Intervention
Intravascular Stenting
Biologic Stent is produced through coagulation
of collagen, ellastin andother tissues in the
vessel wall by laser, photocoagulation or radio
frequency.
It is done to prevent restenosis
after Percutaneous Transluminal Coronary
Angioplasty.
Intervention
Surgical Care
Percutaneous Transluminal Coronary
Angioplasty
Intervention
Emergent or urgent
Coronary Artery Graft Bypass Surgery
(CABG) is indicated
angioplasty fails
Severe narrowing of 1or more coronary artery.
Commonly used: Saphenous vein and internal
mamary artery.
Intervention
Complications
Inflammation
Mechanical
Electrical abnormalities
Cardiac Rehabilitation
Activities:
Exercise may gradually implemented from the
hospital onwards.
Exercise session is terminated if anyone of the
following occurs: cyanosis,cold sweats,
faintness, extreme fatigue, severe dyspnea,
pallor, chest pain, PR more than 100/ min.,
dysrhythmias greater than 160/95mmHg.
Cardiac Rehabilitation