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heart failure heart attack

= heart failure; inability of the heart, to promote the supply of necessary blood volume; clinical syndrome of varying origin, not a disease, eg myocardial infarction, angina pectoris, myocarditis, valvular heart disease, permanent hypertension, cardiac arrhythmias
Symptoms

left heart failure (congestion in pulmonary circulation)	right heart failure (congestion in the systemic circulation)
dyspnea	renal failure / Dysfunction
pulmonary edema	Stauungsgastritis; ascites
cough (Stauungsbronchitis)	ankle edema
"rales	distended neck veins
orthopnea	exertional
tachypnea	liver / spleen enlargement

true for both:

cyanosis

tachycardia

Decreased performance

nocturia

oxygen - reduced supply of the organism

may oliguria

severity

1. NYHA 1: Complete freedom from symptoms are asymptomatic with normal physical activity, affected people (determination by measurement).
2. NYHA 2: Slight limitation of exercise capacity in physical activity.
3. NYHA 3: Strong restriction of capacity even at light physical activity. Dyspnea and fatigue occur.
4. NYHA 4: possible No strain. Every physical activity increased the most in peace insufficiency existing characters such as dyspnea or cyanosis.

[NYHA = New York Heart Association]

Drug therapy

• ACE inhibitor -
• Beta - receptors - Blocker
• diuretics
• digitalis
  

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Definition:
irreversible destruction of heart muscle (myocardial necrosis) caused by insufficient oxygen supply, usually by thrombotic occlusion of the supply section of the coronary vessels.
Cause:
# 95% CHD
# breaking an ulcerated atherosclerotic plaque and thrombus formation of a vessel closure
process of atherosclerosis

	What happened?	What occurs?
1.	fats are deposited on arterial inner wall plaques arise from
second	fat deposits are covered by a connective tissue layer harden	fat deposits are
third thicken form	new muscle cells within the sediments, the vessel walls
4th	caused cracks in hardened deposits	particles dissolve and form a blood clot
5th	Blood clots seal the already narrowed artery, or plaques on break and bleeding occurs	blood supply in the following modified tissue is closed

Drug treatment

• acute phase: analgesics / opioids
• continuous therapy:
  
• CSE inhibitor / lipid lowering agents [CSE = cholesterol synthesis inhibitors]
• antiplatelet anticoagulants

HEART ATTACK DRUG

drug	effect	acute phase	term therapy
morphine analgesia		5-20 mg diluted with NaCl	-
diazepam	sedation	5-10 mg, sc / iv	-
nitrates	dilation of the vessels	Spray Perfusor	tablets
beta-receptor blockers	preventing tachycardia	oral; iv	tablets
heparin (high dose)	preventing thrombus formation, anticoagulation	5000 IU iv bolus; Perfusor 1000 IU / h	-
heparin (low dose)	- "-	1-2 times daily sc	- iv
ASS	platelet aggregation inhibitors	Aspisol;	oral tablet 1 time daily
OR (based on long-term treatment)
warfarin / Falithrom	Vitamin K - antagonist	-	tablet
ADP receptor antagonist	platelet aggregation inhibitors	oral	tablet, about 1 year
thrombolytics	resolution of the thrombus	iv; syringe pump for 1 h	-
ACE inhibitors	-	-	tablets
lipid lowering	lowering cholesterol	-	tablets

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coronary heart disease

ì Synonyms: CHD = coronary artery disease ischemic coronary artery disease

ì Definition: manifestation of atherosclerosis in the coronary arteries.

ì process:

1. 
   
   Atherosclerosis in the coronary arteries


2. 
   
   development of stenosis


3. 
   
   reduced blood flow to the heart muscle


4. 
   
   mismatch between 0 ₂ -demand and O ₂ offer

ì Etiology: [ á increased =]

risk factors of first order 2 risk factors = heart attack risk increased 4-fold 3 risk factors = risk of heart attack 10-fold increase	risk factors of second order
hypertension smoking diabetes mellitus dyslipidemia genetic predisposition age male gender metabolic syndrome	sedentary stress lipoprotein A á fibrinogen á homocysteine á

ì pathophysiology (4 degrees of severity of coronary stenosis)

Grade 1 25 - 49%

; Grade 2 50 - 74% Grade 3 75

- 99% (critical stenosis)

, Grade 4 100% (total occlusion)

Ü only 75% the first symptoms

two forms of CHD

latent coronary heart disease ~ KHK manifest

(asymptomatic (Symptomatische DL)

DL; Stumme ;

Ischämie)

                                                 

diseases manifest CHD

diseases	share of onset (in%)	Description
angina pectoris	55	chest pain due to reversible Myocardischmie
heart attack	25	Ischemic Myocardnekrose
heart failure	-	Ischemic heart muscle damage
arrhythmias	-	ventricular arrhythmias and ventricular fibrillation
Sudden cardiac death	20

ì coronary vessels (coronary arteries)

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Extras:

# are end arteries

#, there are no anastomoses with the einzellne arteries

# dies at closing tissue from

effect of the risk factor nicotine

adrenal medulla:

• 
  
  release of adrenaline and noradrenaline


• 
  
  ð peripheral increase in heart rate


• 
  
  ð increase in O 2 -consumption of the heart

coronary vessels & Vessels:

• 
  
  narrowing of these vessels


• 
  
  ð increased vascular resistance


• 
  
  ð reduced O ₂ offer

vessel walls:

• 
  
  promote platelet aggregation


• 
  
  increase in fibrinogen levels


• 
  
  damage the intima of the arteries


• 
  
  ð increase the clotting ability Blood


• 
  
  ð encouraging early deposits


• 
  
  ð promote atherosclerosis

effect of the risk factor of alcohol

positive	negative reduced
increase in HDL-cholesterol platelet aggregation reduction of fibrinogen in serum blood pressure reduction with low regular alcohol consumption	increase in triglycerides in serum blood pressure with increased regular alcohol consumption (from 30 g / d = 0.3 liters of wine or 0.8 liters of beer)

main complaints / symptoms in diseases of the heart

symptom	statement	differential diagnosis
chest pain	linksthorakal or retrosternal	angina pectoris, pulmonary embolism, heart attack, tuberculosis
dyspnea	breathlessness	pneumonia, lung CA, heart attack, Tbc
palpitations	unpleasant perception of one's own heartbeat	heart attack, hyperthyroidism
cyanosis	bluish discoloration of lips, mucous membranes, skin	hypothermia, pulmonary embolism
distended neck veins	by damming the blood before the right heart	bronchial CA, pericarditis, valve stenosis
nocturia	increased urination at night	right heart failure, urinary incontinence
cough	-	flu, colds, pneumonia
syncope	sudden, brief loss of consciousness, by reducing supply to the brain with O 2	cardiac arrhythmias, arteriosclerosis
reduced exercise capacity	-	-

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wound management

W. is not limited to: *
medically prescribed treatment
; infection prophylaxis
* * Perform emergency measures
but also
# from the wound resulting consequences for those affected
# Instructions and advice of the patient's relatives
+ # collaboration of various institutions during observation

# # #
wound pain observation & documentation treatment
# plot the latest scientific evidence
# Research and Evaluation
objectives of W.

• pain
• Preservation and promotion of the movement
• balanced diet
• maintenance of daily activities / social embeddedness
• acceptance of the altered body image
• boosting self-esteem
• acceptance of new wound dressing materials
• observance of precautions

WOUND = any tissue defect with more or less gaping Gewebsdurchtrennung the outer skin or mucous membrane.
WOUND HEALING = defect closure by Cicatricial supporting tissue related to epithelialization.
wound history

• cause of skin damage
• mobility
• pain
• medication allergies
• nutrition
• acceptance of the wound
  

factors on wound healing

;

local factors	general / systemic factors
location of the wound pressure and mechanical load in the wound area condition of the wound bed temperature fluid secretion from the wound [»exudate ] size of the defect age of wound complications wound healing as an accompanying disease	nutrition age health status immune status Hormone status blood circulation drugs life pain

wound observation
{a} location of the wound

• often regard development
• evidence of appropriate care

{b} wound size

• determined on the basis of wound area and depth
• calculation: Wundlinieal means of the two longest at right angles to each other to determine diameter lines and multiply

{c} wound depth
= Distance between the level of intact skin and wound bed

• measuring point = introduce deepest
• sterile button cannula vertically without sterile cotton swab to the skin surface to the deepest part of the wound, pull dannach and measure

{ d} wound environment

• is evidence of integrity of the skin, healing phase; health
• are observational criteria:
• color
• maceration (Swollen)
• Hautstrucktur
• callus (callus barriers)

{e} wound edge

• direct wound environment is in wound edge over
• important info's {f} on healing tendency of the wound
• vital [healthy] OR nonvital [lifeless]

wound bed / bed

• color & texture = indicator for various phases of wound healing
• Color:
• black / brown = occupied necrotic, dry necrosis
• yellow = fibrinous evidence, pus
• pale pink = unhealthy granulation
• deep pink / pink = healthy granulation Epithelisierungsgewebe
• consistency:
• Œ Nekrosen_trocken, leathery, hard, wet, greasy, scaly
• Granulationsgewebe_leicht-bleeding, glassy, watery, fibrinous occupied, dry, well supplied with blood, shiny wet

{g} =
exudate secretion of fluid wound

• observation criteria are: size, color / appearance, smell

wound healing phases

catabolic phase anabolic phase
~ Inflammation ~ proliferation / / ~ repair

inflammation

• activation of biochemical and cellular processes responsible for the defense against infections & Healing are significant
• leakage of blood and plasma as a result of vascular lesions and local circulation disorders
• bleeding and clotting
• resistance to infection and inflammation
• debridement / wound secretion
• beginning of the epithelialization

, proliferation

• neovascularization as condition for formation of granulation tissue
• granulation (formation of new tissue to the defect filling)
• epithelialization
• infection defense

ƒ repair

• epithelialization
• transformation to scar tissue and scar contraction
• maturation (= maturation of collagen fibers, resulting wound contraction)
  

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Drainagen.doc

TB
8 - Wundmanagement_Selbststudium drainage

drainage

first Indications of drains

A
drainage is in the soft tissue, bone and vascular surgery
induced when blood and wound secretions should be removed from surgical wounds
.

2.

interior drainage	exterior drainage
connection between 2 organs (example: for hydrocephalus, the CSF drainage the ventricles) or seemed a narrowed duct system (eg stents in coronary vessels)	discharge of pus, blood, secretions or body fluid collections outward Open systems Semi-open systems Closed systems

third

Open derivation	suitable for the infected and potentially infected wounds & Stripes ; wicks: manage the wound exudate into the dressing directly from [no receptacle] Corrugated rubber drains: keep open the drainage channel by inserting a plate of rubber or plastic material
	Positive lead secretion relatively painless easier change good wound observation		negative more change, because no collector high (secondary) Infection secretion at the wound infection + remains irritation of the surrounding skin areas
Half open derivation	end on the principle of gravity secretion can proceed in both directions Silikonkapillardrainagen: drains with thin, fluted silicone wall; secretion in a body bag glued derived T-Drain: guided bile post-operatively in a Bag from Robinson Drainage: intraabdominal silicone drainage without suction, but with replaceable bag system
	Positive low infection no manipulation of the wound secretion runs	negative secretion can go back to the wound
Closed systems	wound fluid can flow only in one direction Prerequisite: airtight conclusion of the wound to contraindicated for wounds in the abdominal cavity [ risk of bowel wall damage ] Redon suction drain: suction drainage with controlled suction, negative pressure in the tank secretions actively collects blood + secretion flushing or irrigation-suction drainage: one or two drains with integrated irrigation catheter for continuous flow the peritoneal cavity or an infected joint
	Positive low Infection no manipulation of the wound secretion can occur continuous suction drainage promotes the secretion	negative relatively expensive drainage exchange

4th Change and removal of a
Redon bottle

preparation of the material

• vacuum bottle;
  sterile

  
  

• 
  Péan 2 terminals (if not included in package)

  
  

• disinfectant

  
  

• one document
  [as bed protection]

  
  

• refuse collector

  
  

• gloves

  
  

implementation

• disinfect hands
  

  
  

• required
  objects on disinfected Arbeitsflä che address, check for completeness
  functioning [intact
  vacuum, the flask: the vacuum is intact when the rubber bellow
  is not developed.]

  
  

• patient
  on proposed measure include information

  
  

• 
  window and doors; ask visitors from patient rooms

  
  

• blanket
  retaliate in such a way that will create enough space for changing

  
  

• 
  privacy of the patient note

  
  

• bed protection
  insert

  
  

• 
  wear gloves

  
  

• hose
  for patients with terminal disconnect Péan or tube into the
  narrow place the terminal on the system slide

  
  

• vacuum bottle
  disconnect

  
  

• hose
  from the rubber flange on the bottle turn

  
  

• drainage tube
  with disinfectant spray Connect

  
  

• new
  vacuum bottle, sprayed by passing the
  drainage tube on the approach of the new bottle is screwed
  

  
  

• bottles near
  open terminal; near-patient terminal is still closed

  
  

• near patient
  clamp on the drainage tube slowly open [the action of the new
  suction to the wound can be painful.] Read

  
  

• amount of secretion
  in the old and new bottle ; observe additives and appearance
  
  document

  
  

• drainage
  on integration and suction control

  
  

• 
  patients may support the return bearings and tightening

  
  

follow

• 
  used materials properly disposed of

  
  

• hands
  

  
  

• measure
  disinfect in the maintenance report with hand signals and time to document [+
  secretion quantity, appearance, additions]

  
  

• control
  if both terminals are open, the vacuum bottle under
  patient level depends, vacuum bottle touches the ground
  [infection]

  !
  

5th Hazards / complications of drainage

• 
  Hemorrhage by
  tissue damage (most emanating from the secretion is
  tissue reaction to the foreign material!) »
  additional pain
  

  
  

• Ascending
  infections (through the lumen of the drain, or outside along the tube
  )
  

  
  

• Disabilities
  
  Dislokationsgefahr; risk of falling

  
  

• Allergic reactions
  
  

  
  

6th Association of different techniques
drainage

Silikonkapillar-
("Easy Flow") or latex tube drainage:

• 
  using Stomahesivplatten
  with the smallest possible diameter
  

  
  

• change
  the plates at least 2 times a week
  

  
  

• passage point
  with 0.9% NaCl and sterile swab (if H ₂ O ₂ )
  
  

  
  

Robinson
and T tube:

• 
  exit point is with NaCl
  greinigt 0.9%, a neutral, _{H 2 O 2}
  
  

  
  

• With
  Betaisadonna disinfected
  

  
  

• Sterile
  Schlitzkompresse to exit point
  

  
  

• fixation
  with adhesive bandage
  

  
  

7th Nursing tasks:

a) control of the secretion

• 
  control on size, appearance,
  color, additive, possibly smell
  

  
  

• 
  liquid level of the drainage needs in post-operative Ü , Assumption of the patient
  be marked with date & time
  

  
  

• Several
  drainage enumerate
  

  
  

• if necessary.
  storage for microbiological Investigations
  

  
  

b) control of the drainage system

• 
  secretion drainage, and Sogstärke
  Soggeräusche
  

  
  

• wake
  and consistency check regularly Check
  

  
  

• tubing
  not opened in the system "udders / knead"
  

  
  

• In
  mobilization to reflux of the secretion and eighth
  disconnecting the drainage tube!
  

  
  

c) removing the drainage

• 
  blood drains: Distance
  if only small amounts of blood are encouraged
  

  
  

• abscess drainage:
  distance abscess disappeared soon is Drains are
  previously cut piece by piece so that the drainage channel includes
  
  

  
  

sources
[accessed 15.04.2009]

http://bilder.buecher.de/zusatz/20/20779/20779911_lese_1.pdf

http://www.altenpflegeschueler.de/ care / wunddraiangen.php

© 2009 Matthias Bohr; K1/07

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