EMERGENCY SERVICES

Antonio Costa Antonio Carvalho

INTRODUCTION
When a patient is hospitalized for a heart disease situation, it is often a life
-threatening situation. Observations of nurses are important for diagnosis and t
reatment of the patient. There are no signs or symptoms unimportant. Although th
ere are some exceptions, the signs of heart disease in general correlate with th
e degree of heart disease present.
Antonio Costa Antonio Carvalho
Coronary heart disease
The coronary artery disease is a progressive and insidious, leading to its narro
wing or complete occlusion.
Antonio Costa Antonio Carvalho
Coronary heart disease
The narrowing of the coronary arteries may have multiple causes:
• atherosclerosis • thrombosis • dissection • Coronary spasm • Formation of aneu
rysms
Antonio Costa Antonio Carvalho
Myocardial Infarction MI - An area of death
cell in the cardiac muscle resulting from ischemia usually caused by complete an
d irreversible occlusion of a coronary artery.
Antonio Costa Antonio Carvalho
Angina Angina pectoris - is a syndrome
clinically characterized by paroxysms of pain or pressure in the anterior part o
f the chest that arises as a result of inadequate coronary blood flow and myocar
dial hypoxia. (There is a
disease but a symptom of coronary heart disease).
Antonio Costa Antonio Carvalho
Usual location of anginal pain
The upper anterior chest
Retrosternal area radiating to the neck and jaw
Retrosternal area radiating to M. Left Sup
Epigastric
Epigastric with radiation to the neck and jaw neck, jaw and M. Sup
Shoulder and left limb
Intra-scapular
Antonio Costa Antonio Carvalho
DIAGNOSIS • Signs and symptoms
• ECG Changes
• Changes enzymatic
Antonio Costa Antonio Carvalho
Signs and Symptoms
Pain with or
without irradiation
Pallor
marked
Sweating, moist skin and
viscous
Dizziness Nausea Anxiety Dyspnea Tachycardia /
Bradycardia
Hypotension
Antonio Costa Antonio Carvalho
- Electrocardiographic Changes
• Changes in T wave • Elevation of the ST segment. • Later onset of abnormal Q w
aves.
Antonio Costa Antonio Carvalho
Electrocardiographic changes
Heart strong and regular Able to supply oxygen to the tissues that need
Antonio Costa Antonio Carvalho
Electrocardiographic changes
Atherosclerosis reduces the blood flow and consequently a decrease in oxygen sat
uration in the myocardium, which can lead to angina. (Change in ECG)
Antonio Costa Antonio Carvalho
Electrocardiographic changes
The artery obstruction deprives oxygen area of the myocardium, leading to his de
ath. (Changing its electrical conductivity, producing ECG changes)
Antonio Costa Antonio Carvalho
Electrocardiographic changes may be necessary to carry out stress ECG, echocardi
ography or angiography.
Antonio Costa Antonio Carvalho
Enzymatic changes
The enzymes studied in myocardial necrosis are:
CPK (creatine phosphokinase) and its MB fraction specifies infarction. GOT (
glutamic-oxalacetic transaminase) DHL (LDH) Troponin
Antonio Costa Antonio Carvalho
TREATMENT Objectives:
• Relieve symptoms by decreasing the incidence. • Maintain the largest possible
amount of myocardium. • prevent, divert and treat complications.
Antonio Costa Antonio Carvalho
Nursing care to the sick coronary
• Patient with angina • Patient with EAM
Antonio Costa Antonio Carvalho
Nursing care to patients with angina
Place patient in comfortable position (semi-sitting) to reduce pain and anxiety
of the patient, through the prescribed therapy (nitroglycerin) transmitting calm
and safety evaluation of the sick to other vital parameters determine / confirm
the diagnosis by immediate implementation of ECG features and evaluate kind of
pain and monitoring of heart rhythm steady and continuous
Antonio Costa Antonio Carvalho
Nursing care to patients with angina
Collection of specimens for analysis, providing rapid dispatch to the laboratory
Screening signs and symptoms of possible complications (EAP) administration of
prescribed therapy to promote physical rest
Antonio Costa Antonio Carvalho
Place peripheral venous catheter for administration to maintain a therapeutic en
vironment as calm as possible
Nursing care for patients with AMI
Place patient in comfortable position (semi-sitting) Maintain an environment as
calm as possible, avoiding running and monitoring violations of rhythm and heart
rate constant and permanent, evaluation of other vital parameters Promote deter
mination / confirmation of diagnosis by immediate implementation of ECG Reduce p
ain and anxiety of the patient, through the prescribed therapy (Morphine) transm
itting the patient calm and secure Find rhythm disturbances and heart rate requi
ring emergency treatment (arrhythmias)
Antonio Costa Antonio Carvalho
Evaluate characteristics and type of pain
Nursing care for patients with AMI
Administration of oxygen by nasal cannula (3-5 L / min) Set the peripheral venou
s catheter for therapeutic administration to promote home absolute physical obse
rvation of changes in the patient's psychological state administration of other
therapies prescribed
Antonio Costa Antonio Carvalho
Collection of specimens for analysis, providing rapid dispatch to the laboratory
administration of thrombolytic therapy when prescribed Screening of signs and s
ymptoms of possible complications (arrhythmias, EAP) bladder catheterization and
control of water balance
Nursing care for patients with AMI
Emergency car prepared for possible complications Prepare patient to the coronar
y care unit admission show responsiveness to their questions Promote monitoring
of nursing the sick to the coronary care unit coronary and examinations as a dia
gnostic maintaining continuous monitoring.
Antonio Costa Antonio Carvalho
Search for capillary blood glucose screening for diabetes patient preparation fo
r coronary catheterization, explaining the procedures (and Trichotomy premedicat
ion)
END