In: Nursing
1, PACEMAKER
Pacemaker | Uses | Possible complications | Nursing Implications |
1) According to the number of leads | COMMON NURSING IMPLICATIONS OF PACEMAKERS | ||
a. single chamber pacemaker | helps to correct slow or irregular heart beat. sinus bradycardia, atrial flutter | lead perforation, dyrrhythmias, infections |
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b. dual chamber pacemaker |
helps to regulate the electrical activity of both the chambers bradycardia, atrial fibrillation associated with bradycardia |
lead perforation, dysrhythmias |
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c. Bi- ventricular pacemaker |
unsynchronized heart contraction right and left ventricular failure |
lead dislodgement, lead perforation, dyrhythmias |
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2. Pacemaker according to the programming |
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a. Fixed rate pacemaker | heart beats on regular rate regardless of hearts rate | hematoma, dysrhythmias |
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b. Pacemaker on demand | heart beats according to the intrinsic rate of heart. | infections, hematoma |
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c. Rate responsive pacemaker | increase heart rate accordingto metabolic needs | dysrhythmias, infections, hematoma |
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2. ATHEROSCLEROSIS, ANGINA PECTORIS, MYOCARDIAL INFARCTION
DISEASE CONDITION | PATHOPHYSIOLOGY | CLINICAL MANIFESTATION | TREATMENT |
Coronary Atherosclerosis | It is a build up of plaue in the coronary artery. It cause decresed perfusion of myocardial tissue and an inadequate myocardial oxygen supply leading to hypertension, angina, dysrrhythmias, MI , heart failure and death. Development of collateral circulation takes place. |
Chest pain palpitation dyspnoea syncope cough and hemoptysis, excessive fatigue |
Dietary management and treatment same as angina pectoris |
Angina pectoris | chest pain resulting from myocardial ischemia caused by inadequate myocardial blood and oxygen supply. It is caused by the imabalnec between oxygen supply and demand. |
Stable angina- chest pain aggravates with activity or emotional stress, relieved with rest or nitrogycerin Unstable angina - pain not relieved by nitroglycerin dyspnea, pallor, sweating, palpitation , tachycardia, dizziness and syncope, hypertension, digestive disturbance |
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Myocardial infarction | myocardial tissue abruptly deprived of oxygen leads to necrosis, and become blue and swollen. AFter 48 hrs infarct turns gray with yellow streaks developing as neutrophils invades the tissue. after 8 - 10 days, granulation tissue forms. over 2- 3 months, necrotic area develops as scar permanently changing the size and shape of the entire left ventricle | Crushing substernal pain. radiating pain to the jaw, back, left arm unrelieved by rest or nitroglycerin, nausea, vomiting, diaphoresis, dyspnea, dysrhythmias, feelings of fear and anxiety, pallor cyanosis and coolness of extremity |
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3. Valve replacement procedure
a. Mechanical prosthetic valve : these are durable
b. Bioprosthetic valve - the risk of clot formation is small, long term anticoagulation is not indicated
Interventions - consult with the HCP regarding discontinuing anticoagulants 72hours before surgery, Monitor closely for signs of bleeding, cardiac output and signs of heart failure, administer digoxin as needed
4. MANAGEMENT OF PATIENT WITH HEART FAILURE
5. Nursing care for atherosclerosis and arteriosclerosis
Arteriosclerosis is the stiffening or hardening of the artery walls . atherosclerosis is the narrowing of the artery bacause of the plaque build up. atherosclerosis is a type of arteriosclerosis.
6 Risk factors of hypertension
Non Modifiable risk factors - age , family history, african american race
Modifiable risk factors - obesity, smoking, stress, excessive alcohol , hyper lipedemia, increased intake of salt and caffeine
other disorders - cardiovascular disorders, renal disorders, endocrine system disorders, pregnancy, medications such as estogen, glucocorticoids, mineralocorticoids