最新内科护理学课件-英语-考试资料myocardial+infarction

内科护理学课件英语考试资料myocardial+infarction内科护理学课件英语考试资料myocardial+infaMyocardialinfarction心肌梗死Myocardialinfarction(MIorAMIforacutemyocardialinfarction),alsoknownasaheartattack心脏病发作,occurswhenthebloodsupplytopartoftheheartisinterrupted,resultingischemiaandoxygenshortage,ifleftuntreatedforasufficientperiod,cancausedamageand/ormyocardiuminfarction.Angina心绞痛asaresultofischemiacausesreversiblecellularinjury,andinfarctionistheresultofsustainedischemia,causingirreversiblecellulardeath.Myocardialinfarction心肌梗死Myoc2最新内科护理学课件-英语-考试资料myocardial+infarction3最新内科护理学课件-英语-考试资料myocardial+infarction4最新内科护理学课件-英语-考试资料myocardial+infarction5最新内科护理学课件-英语-考试资料myocardial+infarction6最新内科护理学课件-英语-考试资料myocardial+infarction7最新内科护理学课件-英语-考试资料myocardial+infarction8Healingprocess愈合过程Within24hours:Thebody’sresponsetocelldeathistheinflammationprocess.Leukocytes白细胞infiltratethearea.Enzymes酶arereleasedfromthedeathcardiaccellsandareimportantdiagnosticindicators.Healingprocess愈合过程Within24h9Healingprocess愈合过程Thesecondorthirdday:

Theproteolyticenzymes蛋白水解酶ofneutrophilsandmacrophages巨噬细胞removeallnecrotic坏死

tissueandthenecroticmusclewallisthin.Developmentofcollateralcirculationimprovetheareaofpoorperfusionandmaylimitthezonesofinjuryandinfarction.Onceinfarctiontakesplaces,catecholamine-mediated儿茶酚胺介导lipolysis脂解(作用)andglycogenolysis糖原分解

occur.Forthisreason,serumglucoselevelsarefrequentlyelevatedafterMIandmaybethereasonforapseudodiabeticstate假性糖尿病.Healingprocess愈合过程Thesecond10Healingprocess愈合过程Within4to10days:

ThenecroticzoneisidentifiablebyECGchanges,atthispoint,thephagocytes(neutriphilsandmonocytes中性粒细胞和单核细胞)haveclearthenecroticdebirs坏死的碎片fromtheinjuryareaandthecollagenmatrix胶原基质thatwilleventuallyformthescar瘢痕islaiddown.At10to14day:Thebeginningofscartissue疤痕组织isweak.Themyocardiumisconsideredtobeespeciallyvulnerabletoincreasedstressbecauseoftheunstablestateofthehealingheartwall.6weeksafterMI:

Scartissuehasreplacednecrotictissue,atthistime,theinjuredareaissaidtobehealed.

Healingprocess愈合过程Within4to11Clinicalmanifestation临床表现PainSevere,immobilizingchestpainnotrelievedbyrestornitrateadministrationisthehallmarkofanMI.itisoftendescribedasasensationoftightness,pressure压榨,orsqueezing紧缩.Commonlocationsaresubsternal胸骨下andretrosternal胸骨后.Painradiatesmostoftentotheleftarm,butmayalsoradiatetothelowerjaw下颌，

neck,rightarm,back,andepigastrium腹上部,whereitmaymimicheartburn.Painarecommonlyoccursintheearlymorninghours.Itusuallylastsfor20minutesormore.Clinicalmanifestation临床表现Pai12ClinicalmanifestationNauseaandvomitingNauseaandvomitingcanresultfromreflexstimulationofthevomitingcenterbytheseverpainandcanalsoresultfromvasovagalreflex血管迷走性反射fromtheareaoftheinfarctedmyocardium.Sympatheticstimulation

Diaphoresis发汗,weakness,light-headedness,andpalpitations心悸.Thesesymptomsarelikelyinducedbyamassivesurgeofcatecholamines儿茶酚氨fromthesympatheticnervoussystem

whichoccursinresponsetopainandthehemodynamicabnormalities血流动力学的异常thatresultfromcardiacdysfunction心功能不全.ClinicalmanifestationNausea13ClinicalmanifestationFeverThetemperaturemayincreasewithinthefirst24hourupto38to39.thetemperatureelevationmaylastsforaslongas1week.CardiovascularmanifestationsTheBPandpulseratemaybeelevatedinitially,laterBPmaydropbecauseofdecreasedCO.Urinemaybedecreased.Crackles湿啰音maybenotedinthelungs,persistingforseveralhourstodaysHepaticengorgement肝怒张andperipheraledema外周水肿mayindicatecovertcardiacfailure.Jugularveins

颈静脉

maydistendedandmayhaveobviouspulsations搏动,indicatingearlyrightventriculardysfunctionandpulmonarycongestion.ClinicalmanifestationFever14ComplicationDysrhythmias心律失常:arethemostcommoncomplication,presentin80%ofMIpatient.Theintrinsicrhythmoftheheartburnisdisrupted,causingeitherafastHR(tachycardia心动过速

),aslowHR(bradycardia心动过缓

),oranirregularbeat.Completeheartblock心脏传导阻滞isseeninmassiveinfarction.Ventricularfibrillation室颤,acommoncauseofsuddendeath,isalethaldysrhythmiathatmostoftenoccurswithinthefirst4hoursaftertheonsetofpain.Prematureventricularcontractions室性早搏(PVCs)mayprecedeventriculartachycardia室性心动过速andfibrillation室颤.Ventriculardysrhythmianeedsimmediatetreatment.ComplicationDysrhythmias心律失常15ComplicationCongestiveheartfailureCardiogenicshockPapillarymuscledysfunction乳头肌功能障碍Ventricularaneurysm室壁瘤Pericarditis心包炎Dresslersyndrome德雷斯勒综合征，心肌梗死后综合征Pulmonaryembolism肺栓塞ComplicationCongestiveheart16Diagnosticstudies辅助检查ThreenoninvasivediagnosticparametersareusedtodeterminewhetherapersonhassustainedanacuteMI:Thepatient’shistoryofpain,riskfactorsandhealthhistory.12-leadECGconsistentwithacuteMI(inverted倒置Twaves,

ST-Twaveselevationsofgreaterthan1mmormoreintwocontiguousleads,abnormalQwave)MeasurementofserialmyocardialserumenzymesOthermeasuresincludes:ChestX-rayCBC,thyroidprofileNuclearimagingstudiesEndocardiogramDiagnosticstudies辅助检查Threen17DiagnosticstudiesECGfindingsECGareapproximately80%specificfordiagnosinganacuteMIandrepresentaleadingdiagnosticcriterion.DiagnosticstudiesECGfinding18最新内科护理学课件-英语-考试资料myocardial+infarction19最新内科护理学课件-英语-考试资料myocardial+infarction20Diagnosticstudies辅助检查Cardiacenzymes:AnimportantdiagnosticcriterionforacuteMIislaboratoryassessmentofserialcardiacserumenzymes.Creatinekinase肌酸激酶(CK):CKlevelsbegintoriseapproximately6hoursafteranacuteMIandreturntonormalwithin2to3days.Lacticdehydrogenase乳酸脱氢酶(LDH)Aspartateaminotransferase谷草转氨酶(AST)Diagnosticstudies辅助检查Cardiac21Therapeuticmanagement治疗方案IVtherapy

InitialmanagementofMIisbestaccomplishedinacardiaccareunit(CCU),whereconstantmonitoringisavailable.AnIVrouteisestablishedtoprovideanaccessiblemeansforemergencydrugtherapy.Morphine吗啡sulfatemaybegivenIV2-4mg/hrasneededforreliefofpain(ormeperidine度冷丁ifpatientisallergictomorphine)AcontinuousIVinfusionoflidocaine利多卡因maybegiven,prophylacticallytopreventventricularfibrillation室颤.Therapeuticmanagement治疗方案IVt22Therapeuticmanagement治疗方案OxygentherapyContinualECGmonitoringtodeterdysrhythmiasVitalsignsaretakenfrequentlyduringthefirstfewhoursafteradmissionandaremonitored1-4hrthereafter.Bedrestandlimitationactivityareusualinitially,withagradualincreaseinactivity.RecordingintakeandoutputApulmonaryartery(PA)catheter肺动脉导管andintraarterialline动脉内置管maybeusedtoaccuratelymonitorintracardiac,pulmonaryartery,andsystolicarterialpressuresincomplicatedMIsothatthemosteffectivemodeoftreatmentintheacutephasecanbedetermined.Therapeuticmanagement治疗方案Oxyg23Therapeuticmanagement

Thrombolytictherapy溶栓疗法Itisnowknownthat80%to90%ofallacuteMIaresecondarytothrombusformation.ThrombolytictherapyisthestandardofpracticeinthetreatmentofacuteMI.Myocardialcellsdonodieinstantly.Ittakesapproximately4to6hoursforentirethicknessofthemuscletobecomenecrosedandthisisknownastransmuralinfarction跨壁梗死.TreatmentofacuteMIisgearedtoquicklydissolvingthrombusinthecoronaryarteryandreperfusingthemyocardiumbeforecellulardeathoccurs.Tobeofmostbenefit,thrombolyticsmustbegivenassoonaspossible,perferablywithinthefirst6hoursaftertheonsetofpain.TherapeuticmanagementThrombo24Therapeuticmanagement

Thrombolytictherapy溶栓疗法Thrombolyticagentsusedtotreatmyocardialinfarctionare:streptokinase(链激酶

),urokinase(尿激酶

),tissueplasminogenactivator(t-PA)(组织纤维蛋白溶酶原激活剂).Indicationsofthrombolytictherapy:ChestpaintypicalofacuteMIlessthanorequalto6hrinduration(somecentersextendthetimelimitto12hr).12-leadECGfindingsconsistentwithacuteMI.TherapeuticmanagementThrombo25Thrombolytictherapy溶栓疗法Contraindicationsofthrombolytictherapy:Absolutecontraindications禁忌:HistoryofhemorrhagicstrokeUncontrolledhypertension(SBP>200,DBP>120)Recentsurgeryortrauma(within2wk)ActiveinternalbleedingKnownbleedingdisorderSuspectedaorticdissention主动脉剥离Relativecontraindications:HistoryofstrokeAcute,poorUncontrolledhypertension(BP>180/110)Malignancy妊娠Acutepericarditis急性心包炎Pregnancy妊娠Activepepticulcer活动性消化性溃疡Diabetichemorrhagicretinopathy糖尿病性视网膜病变Artialfibrillation房颤Thrombolytictherapy溶栓疗法Contra26nursingcareforthrombolytictherapyECG,vitalsigns,heartandlungassessmentsarecompletedasoftenasevery5minutestoevaluatethepatient’sresponsetotherapy.Whenreperfusionoccurs,severalclinicalmarkersmayoccurs,nursesshouldmonitorthem,thosesignsofreperfusionincludeschestpainresolution,returnofSTsegmenttobaselineontheECG,thepresenceofreperfusiondysrhythmias再灌注性心律失常(prematureventricularcontractions室性早搏,ventriculartachycardia室性心动过速,ventricularfibrillation心室颤动),rapidriseoftheCKenzymeswithin3hrsoftherapy,peakingwithin12hrs.nursingcareforthrombolytic27nursingcareforthrombolytictherapyAnothermajorconcernwiththerapyisreocclusion动脉重新堵塞oftheartery,becauseofthispossibility,anIVbolusisgiven,followedbyheparindriptomaintainthepatient’sPartialThromboplasmTime(PPT)部分凝血酶原时间atonetotwotimesnormal,thispreventanotherclotformforminginthecoronaryartery.Themajorcomplicationwiththrombolytictherapyisbleeding.Thenursesmustpayparticularattentiontosignsandsymptomsofbleedingsuchasgingivalbleeding牙龈,dropinBP,anincreasinginHR,hematuria血尿,asuddenchangeinpatient’slevelofconsciousnessandoozing渗出ofbloodfromIVorcathetersite.nursingcareforthrombolytic28Therapeuticmanagement

9.PercutaneousCoronaryIntervention(PCI)冠状动脉介入治疗BalloonStentLaserRotablatorTherapeuticmanagement

9.Perc29Percutaneoustransluminalcoronaryangioplasty(PTCA)

经皮腔内冠状动脉成形术. Percutaneoustransluminalcoro30Percutaneoustransluminalcoronaryangioplasy(PTCA)

经皮腔内冠状动脉成形术

. Percutaneoustransluminalcoro31Percutaneoustransluminalcoronaryangioplasy(PTCA)

经皮腔内冠状动脉成形术

. Percutaneoustransluminalcoro32PCIComplication冠状动脉介入治疗的并发症Acuteabruptclosureofcoronaryvesselsseriousarrhythmias:VT室速，VF室颤。Cardiactamponade心包填塞VascularcomplicationLowbloodpressureStrokeHemorrhageRenalfailureHeartattackDeathPCIComplication冠状动脉介入治疗的并发症A33Coronaryarterybypasssurgery(CABG)

冠状动脉搭桥手术Coronaryarterybypasssurgery34Coronaryarterybypasssurgery(CABG)

冠状动脉搭桥手术Coronaryarterybypasssurgery35Pharmacologicmanagement药物管理IVnitroglycerin硝酸甘油IVMorphine吗啡Morphinecanreduceanxiety,decreasecardiacworkload,reducecontractility,lowerBPandslowtheHR.Antidysrhythmicdrugs抗心律失常药物DystrhythmiaarethemostcommoncomplicationsafterMI.Β-BlockersCalciumchannelblockersAngiotensin-convertingenzymeinhibitorsStoolsofteners

Pharmacologicmanagement药物管理I36NutritionmanagementDietisrestrictedinsaturatedfats饱和脂肪和

andcholesterol胆固醇andissometimeslowinsodiumtopreventfluidretention.Thepatientmayhaveaclearliquiddietthefirstdaywhentheremaystillbenausea.NutritionmanagementDietisr37NursingdiagnosisandinterventionAcutepainrelatedtolacticacidproductionfrommyocardialischemiaandalteredmyocardialoxygensupply.Administeroxygenthroughnasalcannulatoincreaseoxygenationofmyocardialtissueandpreventfurthertissueischemia.AdministermorphinesulfateIVasneededtodecreaseanxiety,elevatedpainanddecreasecardiacworkload.Monitorvitalsignsq1-2hrtoprovideon-goingassessmentofpatient’sresponsetotreatment.Nursingdiagnosisandinterven38NursingdiagnosisandinterventionAlteredcardiactissueperfusionrelatedtomyocardialdamage,ineffectiveCOandpotentialpulmonarycongestionProvidelong,uninterruptedrestperiodtopromotecardiacrestandhealing.Minimizecardiacworkloadduringhealing.Explainnecessityofbedrestanddecreasedactivitytopromotepatientcooperation.Allowrestperiodsbetweenconcentratednursingcaretimetoreducefatigueandoxygenrequirementsofmyocardium.Assesurineoutputtodetermineadequacyofrenalbloodflow.Nursingdiagnosisandinterven39NursingdiagnosisandinterventionImpairedgasexchangerelatedtoineffectivebreathingpatternanddecreasedsystemictissueperfusionsecondarytodecreasedCO.Elevatedheadofbedtoallowgravitytolowerthediaghragmanddecreasetheworkofbreathingandreducevenousreturn.Holdmorphineandnotifyphysicianifrespiratoryratelessthan10-12/minbecausemorphineisarespiratorydepressant.Maintainoxygentherapyasorder.Nursingdiagnosisandinterven40NursingdiagnosisandinterventionActivityintolerancerelatedtofatiguesecondarytodecreasedCOandpoorlungandtissueperfusionMeetpatient’sneedquicklyandefficientlytoconserveenergyandpreventanxiety.Encouragepatienttomaintainbedrest.MonitorBP,pulse,respirationandcolortomonitorpatient’sresponsetoactivityandtoadjustasnecessary.AdministeroxygenduringactivitytoincreasesO2availabilityforcardiacandotherorganperfusion.Nursingdiagnosisandinterven41NursingdiagnosisandinterventionConstipationrelatedtoimmobility,changeindiet,possiblefluidrestrictionandmediations.Administerstoolsoftenersasordered.Providebedsidecommode.Instructpatientstoavoidstraining.Providefoodshighinfiber.Ifpatientisunsuccessful,obtainlaxativeorderfromphysiciantofacilitateeasierbowelevacuation.Increasedactivityandambulationastoleratedtoincreaseperistalsisandbowelmotility.Nursingdiagnosisandinterven42NursingdiagnosisandinterventionSleeppatterndisturbancerelatedtocomplextreatmentregimen,pain,anxiety,stressfulenvironmentandfrequentinterruptions.Monitorflowofpeopleintopatient’sroomtoreducenoseandconfusionandpreventsensoryoverload.Plannursingcaretoprovideoptimalresttoencouragemyocardialhealing.Providecalm,restfulenvironmenttoreducestimuliandpromotesleep.Attempttomaintainpatient’ssleep-wakecycle.Ifpatient’sconditioninstable,donotawakenforvitalsignssothatpatientmayhaveanuninterruptedsleepcycle.Nursingdiagnosisandinterven43NursingdiagnosisandinterventionIneffectivemanagementoftherapeuticregimenrelatedtolackofknowledgeofdiseaseprocess,rehabilitation,homeactivities,diet,andmedications.Teachatpatient’slevelofunderstandingtoensurethattheinformationisunderstoodandtoincreaselikelihoodofbehaviorchange.Provideguidelinewithrationaleforrecommendationactionstobetaken.Makerecommendationstopatientinarealisticmanner.Includefamilywheninformationisgiven,especiallyregardinghomecoming,togetcooperationofthepatient’smostsignificantsupportsystem.Bespecificwhengivingdischarginginstructions.Nursingdiagnosisandinterven44最新内科护理学课件-英语-考试资料myocardial+infarction45内科护理学课件英语考试资料myocardial+infarction内科护理学课件英语考试资料myocardial+infaMyocardialinfarction心肌梗死Myocardialinfarction(MIorAMIforacutemyocardialinfarction),alsoknownasaheartattack心脏病发作,occurswhenthebloodsupplytopartoftheheartisinterrupted,resultingischemiaandoxygenshortage,ifleftuntreatedforasufficientperiod,cancausedamageand/ormyocardiuminfarction.Angina心绞痛asaresultofischemiacausesreversiblecellularinjury,andinfarctionistheresultofsustainedischemia,causingirreversiblecellulardeath.Myocardialinfarction心肌梗死Myoc47最新内科护理学课件-英语-考试资料myocardial+infarction48最新内科护理学课件-英语-考试资料myocardial+infarction49最新内科护理学课件-英语-考试资料myocardial+infarction50最新内科护理学课件-英语-考试资料myocardial+infarction51最新内科护理学课件-英语-考试资料myocardial+infarction52最新内科护理学课件-英语-考试资料myocardial+infarction53Healingprocess愈合过程Within24hours:Thebody’sresponsetocelldeathistheinflammationprocess.Leukocytes白细胞infiltratethearea.Enzymes酶arereleasedfromthedeathcardiaccellsandareimportantdiagnosticindicators.Healingprocess愈合过程Within24h54Healingprocess愈合过程Thesecondorthirdday:

Theproteolyticenzymes蛋白水解酶ofneutrophilsandmacrophages巨噬细胞removeallnecrotic坏死

tissueandthenecroticmusclewallisthin.Developmentofcollateralcirculationimprovetheareaofpoorperfusionandmaylimitthezonesofinjuryandinfarction.Onceinfarctiontakesplaces,catecholamine-mediated儿茶酚胺介导lipolysis脂解(作用)andglycogenolysis糖原分解

occur.Forthisreason,serumglucoselevelsarefrequentlyelevatedafterMIandmaybethereasonforapseudodiabeticstate假性糖尿病.Healingprocess愈合过程Thesecond55Healingprocess愈合过程Within4to10days:

ThenecroticzoneisidentifiablebyECGchanges,atthispoint,thephagocytes(neutriphilsandmonocytes中性粒细胞和单核细胞)haveclearthenecroticdebirs坏死的碎片fromtheinjuryareaandthecollagenmatrix胶原基质thatwilleventuallyformthescar瘢痕islaiddown.At10to14day:Thebeginningofscartissue疤痕组织isweak.Themyocardiumisconsideredtobeespeciallyvulnerabletoincreasedstressbecauseoftheunstablestateofthehealingheartwall.6weeksafterMI:

Scartissuehasreplacednecrotictissue,atthistime,theinjuredareaissaidtobehealed.

Healingprocess愈合过程Within4to56Clinicalmanifestation临床表现PainSevere,immobilizingchestpainnotrelievedbyrestornitrateadministrationisthehallmarkofanMI.itisoftendescribedasasensationoftightness,pressure压榨,orsqueezing紧缩.Commonlocationsaresubsternal胸骨下andretrosternal胸骨后.Painradiatesmostoftentotheleftarm,butmayalsoradiatetothelowerjaw下颌，

neck,rightarm,back,andepigastrium腹上部,whereitmaymimicheartburn.Painarecommonlyoccursintheearlymorninghours.Itusuallylastsfor20minutesormore.Clinicalmanifestation临床表现Pai57ClinicalmanifestationNauseaandvomitingNauseaandvomitingcanresultfromreflexstimulationofthevomitingcenterbytheseverpainandcanalsoresultfromvasovagalreflex血管迷走性反射fromtheareaoftheinfarctedmyocardium.Sympatheticstimulation

Diaphoresis发汗,weakness,light-headedness,andpalpitations心悸.Thesesymptomsarelikelyinducedbyamassivesurgeofcatecholamines儿茶酚氨fromthesympatheticnervoussystem

whichoccursinresponsetopainandthehemodynamicabnormalities血流动力学的异常thatresultfromcardiacdysfunction心功能不全.ClinicalmanifestationNausea58ClinicalmanifestationFeverThetemperaturemayincreasewithinthefirst24hourupto38to39.thetemperatureelevationmaylastsforaslongas1week.CardiovascularmanifestationsTheBPandpulseratemaybeelevatedinitially,laterBPmaydropbecauseofdecreasedCO.Urinemaybedecreased.Crackles湿啰音maybenotedinthelungs,persistingforseveralhourstodaysHepaticengorgement肝怒张andperipheraledema外周水肿mayindicatecovertcardiacfailure.Jugularveins

颈静脉

maydistendedandmayhaveobviouspulsations搏动,indicatingearlyrightventriculardysfunctionandpulmonarycongestion.ClinicalmanifestationFever59ComplicationDysrhythmias心律失常:arethemostcommoncomplication,presentin80%ofMIpatient.Theintrinsicrhythmoftheheartburnisdisrupted,causingeitherafastHR(tachycardia心动过速

),aslowHR(bradycardia心动过缓

),oranirregularbeat.Completeheartblock心脏传导阻滞isseeninmassiveinfarction.Ventricularfibrillation室颤,acommoncauseofsuddendeath,isalethaldysrhythmiathatmostoftenoccurswithinthefirst4hoursaftertheonsetofpain.Prematureventricularcontractions室性早搏(PVCs)mayprecedeventriculartachycardia室性心动过速andfibrillation室颤.Ventriculardysrhythmianeedsimmediatetreatment.ComplicationDysrhythmias心律失常60ComplicationCongestiveheartfailureCardiogenicshockPapillarymuscledysfunction乳头肌功能障碍Ventricularaneurysm室壁瘤Pericarditis心包炎Dresslersyndrome德雷斯勒综合征，心肌梗死后综合征Pulmonaryembolism肺栓塞ComplicationCongestiveheart61Diagnosticstudies辅助检查ThreenoninvasivediagnosticparametersareusedtodeterminewhetherapersonhassustainedanacuteMI:Thepatient’shistoryofpain,riskfactorsandhealthhistory.12-leadECGconsistentwithacuteMI(inverted倒置Twaves,

ST-Twaveselevationsofgreaterthan1mmormoreintwocontiguousleads,abnormalQwave)MeasurementofserialmyocardialserumenzymesOthermeasuresincludes:ChestX-rayCBC,thyroidprofileNuclearimagingstudiesEndocardiogramDiagnosticstudies辅助检查Threen62DiagnosticstudiesECGfindingsECGareapproximately80%specificfordiagnosinganacuteMIandrepresentaleadingdiagnosticcriterion.DiagnosticstudiesECGfinding63最新内科护理学课件-英语-考试资料myocardial+infarction64最新内科护理学课件-英语-考试资料myocardial+infarction65Diagnosticstudies辅助检查Cardiacenzymes:AnimportantdiagnosticcriterionforacuteMIislaboratoryassessmentofserialcardiacserumenzymes.Creatinekinase肌酸激酶(CK):CKlevelsbegintoriseapproximately6hoursafteranacuteMIandreturntonormalwithin2to3days.Lacticdehydrogenase乳酸脱氢酶(LDH)Aspartateaminotransferase谷草转氨酶(AST)Diagnosticstudies辅助检查Cardiac66Therapeuticmanagement治疗方案IVtherapy

InitialmanagementofMIisbestaccomplishedinacardiaccareunit(CCU),whereconstantmonitoringisavailable.AnIVrouteisestablishedtoprovideanaccessiblemeansforemergencydrugtherapy.Morphine吗啡sulfatemaybegivenIV2-4mg/hrasneededforreliefofpain(ormeperidine度冷丁ifpatientisallergictomorphine)AcontinuousIVinfusionoflidocaine利多卡因maybegiven,prophylacticallytopreventventricularfibrillation室颤.Therapeuticmanagement治疗方案IVt67Therapeuticmanagement治疗方案OxygentherapyContinualECGmonitoringtodeterdysrhythmiasVitalsignsaretakenfrequentlyduringthefirstfewhoursafteradmissionandaremonitored1-4hrthereafter.Bedrestandlimitationactivityareusualinitially,withagradualincreaseinactivity.RecordingintakeandoutputApulmonaryartery(PA)catheter肺动脉导管andintraarterialline动脉内置管maybeusedtoaccuratelymonitorintracardiac,pulmonaryartery,andsystolicarterialpressuresincomplicatedMIsothatthemosteffectivemodeoftreatmentintheacutephasecanbedetermined.Therapeuticmanagement治疗方案Oxyg68Therapeuticmanagement

Thrombolytictherapy溶栓疗法Itisnowknownthat80%to90%ofallacuteMIaresecondarytothrombusformation.ThrombolytictherapyisthestandardofpracticeinthetreatmentofacuteMI.Myocardialcellsdonodieinstantly.Ittakesapproximately4to6hoursforentirethicknessofthemuscletobecomenecrosedandthisisknownastransmuralinfarction跨壁梗死.TreatmentofacuteMIisgearedtoquicklydissolvingthrombusinthecoronaryarteryandreperfusingthemyocardiumbeforecellulardeathoccurs.Tobeofmostbenefit,thrombolyticsmustbegivenassoonaspossible,perferablywithinthefirst6hoursaftertheonsetofpain.TherapeuticmanagementThrombo69Therapeuticmanagement

Thrombolytictherapy溶栓疗法Thrombolyticagentsusedtotreatmyocardialinfarctionare:streptokinase(链激酶

),urokinase(尿激酶

),tissueplasminogenactivator(t-PA)(组织纤维蛋白溶酶原激活剂).Indicationsofthrombolytictherapy:ChestpaintypicalofacuteMIlessthanorequalto6hrinduration(somecentersextendthetimelimitto12hr).12-leadECGfindingsconsistentwithacuteMI.TherapeuticmanagementThrombo70Thrombolytictherapy溶栓疗法Contraindicationsofthrombolytictherapy:Absolutecontraindications禁忌:HistoryofhemorrhagicstrokeUncontrolledhypertension(SBP>200,DBP>120)Recentsurgeryortrauma(within2wk)ActiveinternalbleedingKnownbleedingdisorderSuspectedaorticdissention主动脉剥离Relativecontraindications:HistoryofstrokeAcute,poorUncontrolledhypertension(BP>180/110)Malignancy妊娠Acutepericarditis急性心包炎Pregnancy妊娠Activepepticulcer活动性消化性溃疡Diabetichemorrhagicretinopathy糖尿病性视网膜病变Artialfibrillation房颤Thrombolytictherapy溶栓疗法Contra71nursingcareforthrombolytictherapyECG,vitalsigns,heartandlungassessmentsarecompletedasoftenasevery5minutestoevaluatethepatient’sresponsetotherapy.Whenreperfusionoccurs,severalclinicalmarkersmayoccurs,nursesshouldmonitorthem,thosesignsofreperfusionincludeschestpainresolution,returnofSTsegmenttobaselineontheECG,thepresenceofreperfusiondysrhythmias再灌注性心律失常(prematureventricularcontractions室性早搏,ventriculartachycardia室性心动过速,ventricularfibrillation心室颤动),rapidriseoftheCKenzymeswithin3hrsoftherapy,peakingwithin12hrs.nursingcareforthrombolytic72nursingcareforthrombolytictherapyAnothermajorconcernwiththerapyisreocclusion动脉重新堵塞oftheartery,becauseofthispossibility,anIVbolusisgiven,followedbyheparindriptomaintainthepatient’sPartialThromboplasmTime(PPT)部分凝血酶原时间atonetotwotimesnormal,thispreventanotherclotformforminginthecoronaryartery.Themajorcomplicationwiththrombolytictherapyisbleeding.Thenursesmustpayparticularattentiontosignsandsymptomsofbleedingsuchasgingivalbleeding牙龈,dropinBP,anincreasinginHR,hematuria血尿,asuddenchangeinpatient’slevelofconsciousnessandoozing渗出ofbloodfromIVorcathetersite.nursingcareforthrombolytic73Therapeuticmanagement

9.PercutaneousCoronaryIntervention(PCI)冠状动脉介入治疗BalloonStentLaserRotablatorTherapeuticmanagement

9.Perc74Percutaneoustransluminalcoronaryangioplasty(PTCA)

经皮腔内冠状动脉成形术. Percutaneoustransluminalcoro75Percutaneoustransluminalcoronaryangioplasy(PTCA)

经皮腔内冠状动脉成形术

. Percutaneoustransluminalcoro76Percutaneoustransluminalcoronaryangioplasy(PTCA)

经皮腔内冠状动脉成形术

. Percutaneoustransluminalcoro77PCIComplication冠状动脉介入治疗的并发症Acuteabruptclosureofcoronaryvesse