Nursing Blog

A myocardial infarction, commonly known as a heart attack, is a medical emergency that occurs when a portion of the heart is deprived of oxygen because of blockage of one of the coronary arteries, which supply the heart muscle (myocardium) with blood. Lack of oxygen causes characteristic chest pain and death of myocardial tissue. Predisposing Factors of Myocardial Infarction Biological risk factors that can not be changed : More than 40 years of age Sex: high incidence in males, whereas in women increases after menopause Heredity Race: higher incidence in blacks. Risk factors that can be modified : Major: Hyperlipidemia Hypertension Smoke Diabetes Obesity Diets high in saturated fat, calories Minor: Physical activity Personality pattern: type A (emotional, aggressive, ambitious, competitive). Excessive psychological stress.

Orthostatic Vital Signs Orthostatic vital signs are a series of vital signs of a patient taken standing, supine and sometimes sitting to form a baseline for analysis and comparison. Used to identify orthostatic hypotension, orthostatic vital signs are commonly taken in triage medicine when a patient presents with vomiting, diarrhea or abdominal pain; with fever; with bleeding; or with syncope, dizziness or weakness. Orthostatic vital signs are not collected where spinal injury seems likely or where the patient is displaying an altered level of consciousness. Additionally, it is omitted when the patient is demonstrating hemodynamic instability, which term is generally used to indicate abnormal or unstable blood pressure but which can also suggest inadequate arterial supply to organs. Orthostatic vital signs are also taken after surgery. The process of taking orthostatic vital signs is also called a "tilt test". A tilt test is judged to be "positive" when the bl

Myocardial Infarction - Mitral Stenosis Mitral stenosis Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart. Symptoms of mitral stenosis include: Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea (PND) Palpitations Chest pain Hemoptysis Thromboembolism in later stages when the left atrial volume is increased (i.e., dilation). The latter leads to increase risk of atrial fibrillation, which increases the risk of blood stasis (motionless). This increases the risk of coagulation. Ascites and edema and hepatomegaly (if right-side heart failure develops) Fatigue and weakness increase with exercise and pregnancy. Myocardial Infarction Myocardial infarction (MI) or acute myocardial infarction (AMI) , commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a co

Complications of Myocardial Infarction The complications of a myocardial infarction are as follows : Arrhythmias – These usually occur within the first 48 hours following an infarct and may be life-threatening. They are due to myocardial irritability caused by lack of oxygen (ischaemia), release of potassium and calcium from dead cells and disturbances to the conductive mechanism of the heart. This is particularly true when the area around the sinoatrial or atrioventricular nodes is affected. Myocardial irritability is identified by the number of ventricular ectopics seen. There is a danger that an ectopic may fall on the T wave (r on T) and ventricular fibrillation ensues. Heart failure – Backpressure from the ventricle affected onto the atrium on the same side exists due to the ventricle being unable to expel the blood in it effectively. This will cause backpressure on either the pulmonary circulation (causing pulmonary oedema) or the systemic circulation (peripheral in organ o

Treatment of Myocardial Infarction The management of a myocardial infarction is with regard to alleviation of symptoms, prevention of extension of the infarct and detection / treatment of the complications of a myocardial infarct. The first priority with these patients is to maintain a clear airway and breathing, monitoring will be established as soon as the patient arrives in the resuscitation room. (NB This will have already been initiated by the ambulance crew). It is also likely that intravenous access will have been established unless the patient was brought in by relatives. A high percentage of prescribed oxygen will be administered via a facemask unless contraindicated by chronic respiratory disease. This will serve to optimise the patient’s oxygenation. Chest pain and nausea are relived by diamorphine and an anti-emetic given intravenously. Diamorphine also acts by offloading the heart and reducing the preload and afterload. If the patient has pulmonary oedema, diuretics

Clinical Manifestations of Myocardial Infarction Pain Chest pain that occurs suddenly and constantly not subside, usually above the sternal region and upper abdomen, this is the main symptom. The severity of pain can increase settled until unbearable pain. Pain is very ill, such as punctured-pin that can spread to the shoulder and continued down to the arm (usually the left arm). The pain started spontaneously (not occur after activity or emotional disturbance), persist for several hours or days, and do not disappear with the help of rest or nitroglycerin (NTG). Pain may spread to the jaw and neck. Pain is often accompanied by shortness of breath, pale, cold, severe diaphoresis, dizziness or head was floating, and nausea and vomiting. Patients with diabetes mellitus will not experience severe pain because of neuropathy that accompany diabetes can interfere neuroreseptor (collect the experience of pain). Laboratory examination Examinat

Glomerulonephritis is a term used to refer to several renal diseases (usually affecting both kidneys). Symptoms Common symptoms of glomerulonephritis are: Blood in the urine (dark, rust-colored, or brown urine) Foamy urine (due to excess protein in the urine) Swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen Symptoms may also include the following: Abdominal pain Blood in the vomit or stools Cough and shortness of breath Diarrhea Excessive urination Fever General ill feeling, fatigue, and loss of appetite Joint or muscle aches Nosebleed The symptoms of chronic kidney disease may develop over time. Many conditions cause or increase the risk for glomerulonephritis, including: Amyloidosis Anti-glomerular basement membrane antibody disease Blood vessel diseases, such as vasculitis or polyarteritis Focal segmental glomerulosclerosis Goodpasture syndrome Heavy use of pain relievers, especially NSAIDs Henoch-Schonlein purpura IgA nephropathy Lupus nephritis Membranoprolifera

Glomerulonephritis is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely, resulting in kidney failure. The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure. Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later. Diagnostic Examinatio

Symptoms of of Chronic Glomerulonephritis This condition causes high blood pressure (hypertension) and chronic kidney failu re. Specific symptoms include: Blood in the urine (dark, rust-colored, or brown urine) Foamy urine Chronic kidney failure symptoms that gradually develop may include the following: Decreased alertness Drowsiness, somnolence, lethargy Confusion, delirium Coma Decreased sensation in the hands, feet, or other areas Decreased urine output Easy bruising or bleeding Fatigue Frequent hiccups General ill feeling (malaise) Generalized itching Headache Increased skin pigmentation -- skin may appear yellow or brown Muscle cramps Muscle twitching Nausea and vomiting Need to urinate at night Seizures Unintentional weight loss Additional symptoms that may be associated with this disease: Blood in the vomit or stools Excessive urination High blood pressure Nosebleed

Complications of COPD Hipoxemia Hipoxemia defined as a decrease in PaO2 values ​​less than 55 mmHg, with oxygen saturation values ​​<85%. At first the client will experience changes in mood, decreased concentration and forgetfulness. At the advanced stage resulting cyanosis. Respiratory Acidosis Arise as a result of the increased value of PaCO2 (hypercapnia). Signs that arise include: headache, fatigue, lethargi, dizzines, tachipnea. Respiratory Infections Acute respiratory infections are caused by increased production of mucus, increased bronchial smooth muscle stimulation and mucosal edema. Lack of air flow will increase the incidence of breath and dyspnea. Heart Failure Especially right heart failure due to lung disease, should be observed particularly in clients with severe dyspnea. This complication often associated with chronic bronchitis, but clients with severe emphysema can also experience this problem. Cardiac Dysrhythmias Arise as a result of hipoxemia, other heart diseas

Management of COPD in Elderly The purpose of the management of COPD are: Improving the ability of people with the symptoms not only in the acute phase, but also the chronic phase. Improving the ability of patients in performing daily activities. Reducing the rate of progression of disease when the disease can be detected early. Management of COPD in the elderly, as follows: Eliminate etiologic factors / precipitation, for example, immediately stop smoking, avoid air pollution. Cleaning the bronchial secretions with the help of a variety of ways. Eradicate the infection with antimicrobial. In the absence of antimicrobial infection need not be given. Provision of appropriate antimicrobial should be in accordance with the germs that cause infections of appropriate sensitivity test results or empirical treatment. Overcoming bronchospasm with bronchodilator drugs. The use of corticosteroids to resolve the inflammatory process (bronchospasm) is still controversial. Symptomatic treatm

Chronic obstructive Pulmonary Disease (COPD) is comprised primarily of three related conditions - chronic bronchitis, chronic asthma , and emphysema. In each condition there is chronic obstruction of the flow of air through the airways and out of the lungs, and the obstruction generally is permanent and may be progressive over time. Chronic Obstructive Pulmonary Disease ( COPD ) is a chronic lung disease . COPD is characterized by limitation of airflow in the airway that is not fully reversible , is progressive , and is usually caused by inflammation of the lung caused by exposure to harmful gases that can give you an idea of systemic disorders . These disorders are preventable and treatable . The main cause of COPD is cigarette, smoke pollution from combustion, hazardous gases and particles. Impaired airflow in the airway caused lung inflammation that causes a combination of small airway disease (small airway disease) and parenchymal destruction (emphysema). Signs and Symptoms f

Management of Emphysema Emphysema is also treated by supporting the breathing with anticholinergics, bronchodilators, steroid medication (inhaled or oral), effective body positioning (High Fowlers), and supplemental oxygen as required. Treating the patient's other conditions including gastric reflux and allergies may improve lung function. Supplemental oxygen used as prescribed (usually more than 20 hours per day) is the only non-surgical treatment which has been shown to prolong life in emphysema patients. There are lightweight portable oxygen systems which allow patients increased mobility. Patients can fly, cruise, and work while using supplemental oxygen. Other medications are being researched. Lung volume reduction surgery (LVRS) can improve the quality of life for certain carefully selected patients. It can be done by different methods, some of which are minimally invasive. In July 2006 a new treatment, placing tiny valves in passages leading to diseased lung areas, was anno

Signs and Symptoms of Emphysema Emphysema is a disease of the lung tissue caused by destruction of structures feeding the alveoli, in some cases owing to the action of alpha 1-antitrypsin deficiency. Smoking is one major cause of this destruction, which causes the small airways in the lungs to collapse during forced exhalation. As a result, airflow is impeded and air becomes trapped, just as in other obstructive lung diseases. Symptoms include shortness of breath on exertion, and an expanded chest. People with this disease do not get enough oxygen and cannot remove carbon dioxide from their blood; they therefore exhibit dyspnea (shortness of breath). At first this occurs only during physical activity. Eventually it will occur after any physical exertion. Later the patient may be dyspneic all the time, even when relaxing. Because breathing is difficult, the patient must use accessory muscles to help them breathe; tachypnea (rapid breathing) may occur they try to extend their exertion.

Pathophysiology of Bronchitis Acute bronchitis may arise in a single attack or may arise again as an acute exacerbation of chronic bronchitis . In the upper respiratory tract infection, usually viral, is often the beginning of acute bronchitis attacks. Doctors will diagnose chronic bronchitis if the client has a cough or sputum production for several days + 3 months in 1 year and at least 2 years in a row. Bronchitis arise as a result of exposure to infectious agents and non-infectious (especially cigarette tobacco.) Irritants will cause an inflammatory response that will cause vasodilatation, congestion, mucosal edema and bronchospasme. Clients with chronic bronchitis will experience: Increasing the size and number of mucous glands in the large bronchi, which will increase mucus production. More viscous mucus. Cilliary malfunctions which could reduce mucus clearance mechanisms. Therefore, "mucocilliary defense" of lung damage and increase the propensity for infection. Wh

Osteoarthritis is a condition in which the joint pain caused by mild inflammation arising from friction ends of the bones making up the joint . Consists of primary osteoarthritis Osteoarthritis also known as degenerative arthritis or degenerative joint disease , and secondary osteoarthritis caused by trauma or injury tropism . In the joints , a cartilage tissue which is called by the name of cartilage usually closes the ends of the bones making up the joint . A layer of fluid called synovial fluid located between the bones and acts as a lubricant that prevents the ends of the bones rub against each other and scrape one another . On the condition of lack of synovial fluid cartilage layer that covers the ends of bones will rub against each other . The friction will make the layer gets thinner and eventually will cause pain . Clinical Manifestations of osteoarthritis , including: Pain in joints Is the primary image in osteoarthritis, the pain will increase when it is doing something phy

Pathophysiology of Osteoarthritis Degenerative joint disease is a chronic disease, not inflamed, and slowly progressive, which seemed to be an aging process, joint cartilage decline and degeneration accompanied by new bone growth at the edges of the joints. The process of degeneration is caused by chondrocyte-solving process which is an important element of joint cartilage. Solving the allegedly initiated by certain biomechanical stress. Expenditure lysosomes causes dipecahnya polysaccharide enzyme proteins that form the matrix around chondrocytes resulting in cartilage damage. The joints most often affected are the joints that must bear weight, like knee and hip spine. Interfalanga distal joints and proksimasi. Osteoarthritis in some cases will result in limited motion. This is caused by the pain suffered by or caused by narrowing of joint space or less use of these joints. Degenerative changes that result because of certain events such as injury hinge joint infection and congeni