Pathophysiology of angina explained. (2018)

 

49 yo Bill Gordon comes into the emergency department reporting a sudden onset of chest pain described as ‘an elephant sitting on my chest.’ He is also short of breath and diaphoretic. His past medical history includes hypertension, hypercholesterolemia and angina. You suspect that he may be having a myocardial infarction (MI).
Describe the pathophysiology of myocardial infarction. How is this different to angina?
Myocardial infarction is an excruciating pain that spreads to the arms jaw and the back of the body. When the heart doesn’t get enough blood and or the inadequate supply of oxygen to the heart muscle, and this causes of the blockage or a plaques build up in the coronary arteries which will compromise blood flows to the heart muscle and end up a heart attack or myocardial infarction-death of tissues. Whereas, Angina is chest pain describing as a pressing or squeezing sensation felt at the sternum and if angina symptom-the chest pain is not managed well due to delayed interventions may end up in myocardial infarction.
(“Pathophysiology of angina explained”, 2018)

Pathophysiology of angina explained. (2018). Nutralegacy.com. Retrieved 31 March 2018, from http://www.nutralegacy.com/blog/general-healthcare/pathophysiology-of-angina-explained/

Comment:
A myocardial infarction is not the excruciating pain that spreads to the arms jaw and the back of the body. You have listed some symptoms of an MI but it is not the correct definition.
“When the heart doesn’t get enough blood” – this means that no blood is being pumped through the atrium and ventricles, which is incorrect. ‘When the heart muscle doesn’t get enough blood’, is what you should have stated.
“the inadequate supply of oxygen to the heart muscle and this causes of the blockage or a plaques build up in the coronary arteries”. Poor perfusion of the myocardium is not the cause of vascular obstruction or plaque build-up within the coronary arteries – it is the other way around. Plaque build-up causes poor perfusion of the myocardium.
“myocardial infarction-death of tissues” – the death of myocardial tissue, not all tissues or any other tissues. You have to be specific Marjorie or else your answer is incorrect.
An AMI is an occlusion of a coronary blood vessel leading to a decrease in blood flow to the coronary arteries, decreased oxygen supply, ischemia, myocardial cellular injury and ultimately myocardial cell death.
Angina occurs as a result of the decreased supply of blood to the myocardium, just as that which occurs in an AMI. The chest pain and possible radiating pain to left arm and jaw are just as that which occurs in an AMI however, it does not result in permanent damage to myocardial cells. An AMI results from complete occlusion and can lead to permanent myocardial cell death.
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49 yo Bill Gordon comes into the emergency department reporting a sudden onset of chest pain described as ‘an elephant sitting on my chest.’ He is also short of breath and diaphoretic. His past medical history includes hypertension, hypercholesterolemia and angina. You suspect that he may be having a myocardial infarction (MI).
What is your nursing management of a patient with chest pain?
Assess the patient and obtain vital signs and get the patient to rest and ask the patient where the pain radiates the location and intensity of the pain. Check vital signs before and after narcotic medication prescribe by the doctor.
Perform an ECG
Obtain a blood test
monitor
Report to be reviewed by the doctor and assess for further test Document and continue monitoring of the patient
Comments
Comment:
“Obtain a blood test” – which blood test
“monitor” – what exactly are you monitoring?
Narcotic analgesia is not the first line of treatment in Angina.
You forgot to include;
• Cardiac monitoring
• Administer GTN as per hospital policy (check systolic BP)
• Oxygen therapy as per policy (usually applied if Sp02 is <93% or there is evidence of shock)
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49 yo Bill Gordon comes into the emergency department reporting a sudden onset of chest pain described as ‘an elephant sitting on my chest.’ He is also short of breath and diaphoretic. His past medical history includes hypertension, hypercholesterolemia and angina. You suspect that he may be having a myocardial infarction (MI).
You are asked to prepare Bill to go to the catheter laboratory for an angiogram +/- stent. Please describe what this procedure involves?
A cardiologist is performing angioplasty and stents to your heart.
An x-ray uses special dye and camera to detect blockages in the arteries where a thin plastic tube called a sheath inserted into an artery; it could be in the groin or arm. Then a catheter is passed through the sheath and guided up a blood vessel to the surrounding the heart.
Angioplasty is used to widen blocked coronary arteries heart disease improving blood supply to the heart: stents are positioned inside as a scaffold to help keep the artery open. They then released the medication into the surrounding area to help reduce of narrowing the artery.(Daniel Lee Kulick, 2018)
Daniel Lee Kulick, F. (2018). Coronary Angiogram: Read What Happens During the Procedure. MedicineNet. Retrieved 1 April 2018, from https://www.medicinenet.com/coronary_angiogram/article.htm
Comments
Comment:
The question asks you to describe what an angiogram is. You have mentioned that a cardiologist performs an angioplasty – not asked – and you have described what an angioplasty is – once again, not asked. You state than an x-ray uses special dye. An x-ray is a picture. The dye makes the insides of an artery visible on x-ray. A thin plastic tube is inserted into an artery in an angioplasty, not an angiogram.
A coronary angiogram is a procedure which looks closely at the internal structure of your coronary arteries and reveals if they are narrowed or blocked. A special type of X-ray dye is administered via the femoral artery so that you can visualise the insides of the coronary arteries via the x-ray. A thin tube is not inserted into the artery, this is what occurs in an angioplasty.
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You are on clinical placement in the country where they use thrombolysis for acute MI. How does this help a patient with an MI?
it is a therapy or a medication administered to a patient with MI to dissolve clots that have blocked major arteries or veins. The drug circulates within the bloodstream until it reaches the clot, lessening the effect of the heart attack.

Thrombolysis| Australian & New Zealand Society for Vascular Surgery. (2018). Anzsvs.org.au. Retrieved 1 April 2018, from http://www.anzsvs.org.au/patient-information/thrombolysis/

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Thrombolysis aims to dissolve the thrombi occluding the coronary artery to achieve reperfusion. This helps to reduce the size of the infarct, preserving cardiac functioning and improving survival.
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What is septic shock and what are some of the clinical manifestations?
septic shock is a severe medical condition that widespread of infection, a sepsis or body’s response to a disease that damages its tissues and organ due to a complication of infection and it is life-threatening those who are affected
clinical manifestations are fever, confusion, anxiety, shortness of breath, nausea and vomiting, producing less urine, diarrhea, as well as severe muscle pain.

Healthyliving.azcentral.com. Retrieved 28 March 2018, from https://healthyliving.azcentral.com/nutrition/
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Comment:
“septic shock is a severe medical condition that widespread of infection, a sepsis or body’s response to a disease that damages its tissues and organ due to a complication of infection and it is life-threatening those who are affected”
This does not make sense but I understand what you are trying to say. You really need to improve your English grammar and punctuation skills Marjorie as we cannot have the reader guessing what you are trying to say. Septic shock is the most common type of shock and is caused by widespread infection. Older patients are more at risk because of decreasing physiological reserves and an ageing immune system. Nosocomial infection in critically ill patients most frequently originate in the blood, lungs and urinary tract.
Immunocompromised patients (malnutrition, alcoholism, malignancy and diabetes), invasive procedures and indwelling medical devices, increased number of resistant micro-organisms and older population. Some activities to reduce these risk factors include debriding wounds, infection control practices, aseptic procedures, proper cleaning of equipment and hand hygiene.
Clinical Manifestations Tachycardia, febrile or hypothermia, tachypnoea, decreased urinary output, nausea & vomiting, confusion, agitation, hypotension, cool and pale skin.

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