انت هنا الان : شبكة جامعة بابل > موقع الكلية > نظام التعليم الالكتروني > مشاهدة المحاضرة
الكلية كلية التمريض
القسم قسم التمريض العام
المرحلة 2
أستاذ المادة حسام عباس داود السلطاني
6/25/2011 10:07:41 AM
College of Nursing
Second stage /Adults Nursing
Assistant lecturer / Hussam Abbas
Angina pectoris
Definition
Is chest pain caused by inadequate myocardial oxygen supply result from narrowing of the coronary arteries .
Causes:
1-Atherosclerosis.
2-Vasospasm
3-Aortic stenosis
4-Hypertension
5-Genetic
6-smoking
7- Alcohol
Signs and Symptoms:
1-Substernal ,crushing pain
a-Radiate to the arms
b-pain duration 3 to5 min
c-Usually occurs after exertion, emotional excitement or exposure to cold but also can develop when the patient is at rest
2-Dyspnea
3-Palpitations
4-Tachycardia
5- Sweating
6- Epigastric distress
7- Anxiety
Diagnostic Test:
1-ECG:ST depression ,T wave inversion during acute pain
2-Stress test
3-Coronary arteriography
4-Holter monitoring
5-Cardiac enzymes
6-Blood chemistry :increase cholesterol
Nursing interventions :
1-Assess pulse rate ,blood pressure and respiration rate
2-Assess chest pain
3-Give O2 by mask
4-Assess cardiovascular status
5- Give medication as order
6-Keep the patient in semi-fowlers position
7-Monitor and record vital signs
8-Obtain ECG reading during an acute attack
9-Maintain the diet :low- sodium, low-calorie and low-cholesterol
10-Advise the patient to rest if pain begins
11-Monitor laboratory tests
12-Encourage the patient to express fears
13-Educate the patient stop smoking and check blood pressure daily
14-Teach the patient about dose ,time ,side effect of drug and avoid stress
Medical management to angina pectoris is PTCA if necessary.
Complications:
1-Myocardial infarction
2-Congestive heart failure
3-Arrhythmias
4-Cardiogenic shock
5-Cardiac arrest
Varicose Veins
• Dilated and twisted leg veins resulting
from blood congestion due to
incompetent valves in the blood vessels.
• Risk factors are :
- Prolonged standing & sitting as well
-Genetic
-Weakness of the veins
Signs & Symptoms
• Leg fatigue
• Leg Pain
• Dilated veins
• Ankle edema
• Leg cramps
• Heavy feeling in legs
Diagnostics
• Trendelenburg’s test: measures filling
time
• Venogram
• Doppler ultrasound
Medical/Surgical Treatment
• Elevate legs
• Rest periods
• Sclerotherapy: injection of solution at
the site of the varicosities.
• Vein ligation
• Vein stripping
Nursing Interventions
1• Monitor incision after surgery
2• Check circulation
3• Assess elastic wraps q shift
4• Elevate affected leg
5• Monitor for sensory loss in leg
• Monitor pain & s/s infection6
Patient education
1• Continue to wear support hose at home
2• Avoid prolonged sitting, elevate legs,
walk around every hour
3• Don’t cross legs when sitting
4• Weight management
5• Prevent injury
Arteriosclerosis Obliterans
• A chronic progressive thickening of
The intima leading to stenosis or obstruction of alumen.
• Obliteration= Destruction or complete
occlusion of a part by degeneration,
disease, or surgery
Signs & Symptoms
• Pain the first symptom. Occurs from
tissue ischemia.
• Activity causes need for more blood
To tissue. Activity causes ischemia
Which causes pain in an affected extremity
• Pain, pulselessness, pallor, paresthesia paralysis.
• Chronic arterial occlusion: Rubor color
which indicates inflammation. Cyanosis
which indicates possible gangrenous
changes
Diagnostics
• Treadmill testing
• Digital subtraction angiography (allows
bony structures to be obliterated from the picture.)
• Doppler ultrasound
• MRI
• Angiography (Enable to accurately identify andlocate occlusions)
Medical Management
• Medications used to prevent complete
occulsion
– Anticoagulants
– Fibrinolytics (Urokinase injected into the thrombus)
_Vasodilators
Surgical Intervention
1• Embolectomy: removal of clot
2• Endarterectomy: removal of lining of
the artery
3• Arterial bypass: using graft material to
bypass obsturction
3• Percutaneous transluminal angioplasty
• In severe or advanced cases amputation 4
Nursing Intervention
1• Prevent hazards of immobility
2• Balance exercise and rest to promote
circulation
3• Use pain as a guide to activity
limitations
4• Leg in dependent position relative to
heart to improve circulation
5• Mark location of peripheral pulse with
pain to identify. Be watchful for changes
6• Promote vasodilation by providing
warmth to extremities
7• Avoid vasoconstriction ie; nicotine,
caffeine, stress, chilling
8• Avoid constriction to vessels in legs
9• Assess circulation
10• Alert nurse/physician if circulation decrease
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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