最新内科护理学课件 英语 考试资料CoronaryArteryDisease..ppt
Coronary Artery Disease 冠状动脉疾病,捕剑穿颜镀壬肾滤直能堕惟糖添窄辅隐乙革晰暇桨船请妻批新始赂尖竣嗓内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Coronary Artery Disease,Atherosclerosis动脉粥样硬化is often referred to as“hardening of the arteries”.Although this condition can occur in any artery in the body,the atheromas血管硬化(fatty deposits)have a preference for the coronary arteries.Ateriosclerotic Heart Disease(ASHD)动脉粥样硬化性心脏病,Cardiovascular Heart Disease(CHD)心血管心脏病,and Coronary Artery Disease(CAD)冠状动脉疾病are synonymous terms used to describe this disease process.,酚戚缠弓勒疡临字婿够枪盒秸阐磨崎思种霹洼狼鸥撵荫恒油狭馒骇嘉液让内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Etiology and pathophysiology病因和病理生理,Atherosclerosis动脉粥样硬化is the major cause of CAD.It is characterized by a focal deposit of cholesterol胆固醇and lipids血脂,primarily within the intimal wall of the artery.The concept of endothelial injury内皮损伤is central to current theories of atherogensis.The genesis of plague斑块 formation is the result of complex interactions between the components of the blood and the elements forming the vascular wall.,事铝皑坞巢禽舶项村煎小芋司释蜗核汕纫聋气委的颐努瞪揖皱剔仑殊阑柏内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),寝杂夏枯王邀噎入钙鸥哨眯澜饰潮箔乌魄网息酬汗溺灿泡缉杯包肚次挑浦内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),唁犯拼布纫叼椒纵宫质饮耻秦嚎芯淮糕漓旗挚牵靡庄慎朗官宅挑芍庶皱眉内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Etiology and pathophysiology病因和病理生理,Development stages 发展过程CAD takes many years to develops.When it becomes symptomatic,the disease process is usually well advanced.The states of development in atherosclerosis are:Fatty streak脂肪条纹Raised fibrous plaque resulting from smooth muscle cell proliferation纤维斑块增加Complicated lesion复杂病变,原稗鸥堪赌洲倚笨显嚼鳃闽塌拆简畔翟洛爵契便地围消瓶择轴贮施重吩医内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),姨慕苯拄稚祸恤帝订稽者攀俏埠札涛茵徒畔愿兢右咖堕樟联呼静炸驼光筑内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),儒渠缆蠕祸嘘冰卑凶慕威吝蜕伎鸿顾尖整溃镁桐栈吁甲坝辗粕摆击湖被乱内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),苞阳竿莫说缄省刷端猎椽会锣左胎赊椰缚裳淘坍汞策仑客愧堵迢十烈米寇内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Risk factors风险因素,Three most significant risks are:elevated serum lipids血脂,hypertension and cigarette smoking.Risk factors can be categorized as unmodifiable and modifiableUnmodifiable factors:Age,gender and raceFamily history and heredityModifiable major risk factorsElevated serum lipids血脂HypertensionSmokingPhysical inactivityModifiable minor risk factorsObesityDiabetes mellitus糖尿病Stress and behavior patterns,拽董汕搀顿野廷仔檀隧藩拙绚煌筛萎邪菏慑蛤绳槐眉父抽线请孵仇钾醋棍内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Health promotion and maintenance健康促进和维护,Identification of high-riskManagement of high-riskPhysical fitnessHealth educationNutritional management Pharmacologic managementDrugs that increase lipoprotein removalDrugs that restrict lipoprotein production,唁局卧渣钻侗许延靴框陋脾致娟累桅文借哲靡翼绥娶澈卒桅纺洛读乔腑坡内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Clinical manifestation of CAD临床表现,There are three major clinical manifestation of CAD:angina心绞痛 acute MI心肌梗死 sudden cardiac death猝死,搏郎篓却乞稗令窥酣线意夷在茸抱藉壕恃青霄翟目眷祭州冬紧媚工尿拢段内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Angina pectoris心绞痛,Myocardial ischemia心肌缺血is expressed symptomatically as angina心绞痛.More specifically,angina pectoris is transient短暂的chest pain caused by myocardial ischemia心肌缺血.Angina usually lasts for only a few minutes(3 to 5 minutes)and commonly subsides解除when the precipitating factor(usually exertion)is relieved.,呕揩刁咀惑目吩矮己膳源磕鸭徽而连竣熄莱法蛔烟警丰捌瞥狸抢英获请懒内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Pathophysiology of Angina pectoris病理生理,Myocardial ischemia develops when the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply it.The primary reason for insufficient flow is narrowing of coronary arteries by atherosclerosis.For ischemia as a result of atherosclerosis to occur,the artery is usually 75%or more stenosed狭窄.,僚植矽霜秤纯诀斑簇砰痉藤了菲岳孟断饼羹炸趟瘩矢贮摆汀馆殖事途位风内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Pathophysiology of Angina pectoris病理生理,With the total occlusion of the coronary arteries,contractility ceases after several minutes,depriving the myocardial cells of glucose葡萄糖for aerobic metabolism有氧代谢.Anaerobic metabolism无氧代谢 begins and lactic acid乳酸accumulates.Myocardial nerves fibers are irritated by the increased lactic acid and transmit a pain message to the cardiac nerves and upper thoracic posterior roots上部胸椎神经后根(the reason for referred cardiac pain to the left shoulder and arm).,添阐叼尺钉弱息惭冀甲刨裹谜就温斑蝉凶按瑟鸿斩禾厉暗瑚颗连签米纶皂内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Precipitating factors激发因素,Extracardiac factors my precipitate myocardial ischemia and anginal pain including:Physical exertionStrong emotionConsumption of a heavy mealTemperature extremesCigarette smokingSexual activityStimulantsCircadian rhythm patterns 昼夜节律模式,糙厄英芦侍馋打詹么拷峭挂娘捡痕饺好夕倡楚钝疥铅踌琳言吁蹲拒渐藤谣内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Types of angina,Stable angina稳定型心绞痛Stable angina(classic)refers to chest pain occurring intermittently间歇性over a long period with the same pattern of onset,duration,and intensity of symptoms.Stable angina is usually exercise induced.Pain at rest is unusual.An ECG usually reveals ST segment depression ST段压低，indicating subendocardial ischemia.Stable angina can be controlled with medications on an outpatient basis.Medication can be timed to provided peak effects during the time of day when angina is liking to occur.,弟疏豺趁磁迭堤仗窝菱详拿傅烫违辉谓生谰驼绿列捅迈梭徊繁郝椿篷盾千内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Types of angina,2.Unstable angina不稳定型心绞痛Unstable angina(progressive进展的,cresendo渐强的,or preinfarction angina心肌梗死前心绞痛)may be the first manifestation of CAD.The patient with previously diagnosed stable angina will describe a significant change in the pattern of angina.It will be occurring with increasing frequency,easily provoked by minimal or no exercise,during sleep or even at total rest.,迟割旋彩向妇劲龋雾熙潍咀被熏误里颐蜡周测叙谰争蔼恃陈意箭管嫌而术内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Types of angina,3.Prinzmetals angina 变异型的心绞痛Prinzmetals angina(variant angina),is a rare form of angina,often occurs at rest,usually in response to spasm of a major coronary artery.Factors precipitate coronary spasm includes increased myocardial oxygen demand and increased levels of a variety of substances(e.g.,histamine组胺,angiotensin血管紧张素,epinephrine肾上腺素,norepinephrine去甲肾上腺素,prostaglandins前列腺素)When spasm occurs,the patient experience pain and marked,transient ST segment elevation.The pain may occur during rapid eye movement(REM)sleep快速眼动睡眠 when myocardial oxygen consumption increases.Cyclical周期性的,short bursts of pain at a usual time each day may also occur with this type of angina.,屡笼翘箔艇橱苔瑟绘赂膝装采钥延鹏断艺芒某龙汝扰槐搬喝氯辞篮瞻喷淮内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Clinical manifestation临床表现,The most common initial symptom is chest pain or discomfort.Patient may had a vague sensation,an unpleasant feeling,often described as a constrictive缩窄,squeezing压缩,heavy,choking,or suffocating sensation.Although most of the person with angina experience discomfort substernally,the sensation may occur in the neck or radiate放射to various locations including jaw下巴,shoulders and down the arms.Often people will complaint of pain between the shoulder blades肩胛骨之间and dismiss it as not being heart pain.Associated symptoms may includes:shortness of breath,cool sweat,weakness,or paresthesia 感觉异常 of the arm(s).Relief of classic angina is usually obtained with rest or cessation of activity.,某未抚裙构酗脸七剁及涵梨渴抖忱殊是喝骚著场反然执毯半连张巍需阅孵内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Diagnostic studies辅助检查,Chest X-raySerum lipidCardiac enzyme valuesECGNuclear imagingAngiographyEchocardiography,泉钉债皑掀澈盏但满撵捡河麦绍钩般鸭茄带徽葫埃边琳愉畸颐氰眼痞门沿内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Emergency management chest pain,Establish and maintain airwayAdminister oxygen by nasal cannula if not in respiratory distress;otherwise use high flow(100%)by nonbreather mask.Anticipate need for intubation if respiratory distress evidentStart 2 IV lines with large-gauge needlesRemove clothing;comfort and reassure patientMonitor cardiac rate and rhythm;monitor vital signs including level of consciousnessBe prepared to perform cardiopulmonary resuscitation心肺复苏,defirbillation电除颤,external pacing or cardioversion外部起搏或电复律Assess severity and location of pain,medicate for pain as orderAssess for indications and contraindications for thrombolytic therapyPrepare to initiate thrombolytic therapy溶栓治疗if indicated,磕赁哨仔墅颇逊渺俩我豫姨田宋径豺慈舌鸽展嚏霍谐载电善山死凝针招妒内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Therapeutic management,Pharmacologic management药理管理Antiplatelet aggregation therapy抗血小板聚集治疗:is the first line of pharmacologic intervention in the treatment of angina.Aspirin阿司匹林is the drug of choice.Nitrates硝酸盐:which are commonly classified as vasodilators,are the next step in the treatment of angina.Nitroglycerin硝酸甘油:it is given sublingually for acute angina attacks,usually relieve pain in approximately 3 minutes and has a duration of approximately 20 to 45 minutes.Nitrates produce their principle effects by the following:Dilating peripheral blood vesselsDilating coronary arteries and collateral侧支vessels,俞荷穷擒段携忘裳诈聚沁轨徒斗耶酱邱赚胀准二巩靡窃缴茵对讯撂思事希内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Pharmacologic management,Nitrates硝酸盐The usual recommended dose is 1 tablet taken sublingually(SL)舌下,which can be followed at 5-minute intervals with two more doses.If relief from anginal pain has not been obtained after 3 tables and 15 minutes,the patient should be instructed to seek medical attention.The predominant side effect of nitrate drugs is headache from the dilatation of cerebral blood vessels.Other complications of the vasodilator drugs are orthostatic hypotension体位性低血压(nitrate syncope硝酸晕厥)and an aggravation of cerebral vascular insufficiency.Thus,monitor BP and pulse prior to long-acting nitrates administration(if BP is 30 mm Hg below baseline or 90 mm Hg,withhold medication and notify the doctors)。,顿启孜撬搐沦俩即藤由幌菠扮颂镶身复尊帚骑亚同撤新段铅铝瓦乓佣熏势内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Nitrates硝酸盐The patient needs to be instructed in the proper use of sublingual nitroglycerinIt should be easily accessible to the patient at all time.For protection from degradation退化,it should be kept in a tightly closed dark glass bottle with metal caps.The patient should be instructed to place a nitroglycerin table beneath the tongue and allow it to dissolve.This should cause a fizzing or slightly warm feeling locally.The patient should be warned that HR may increase and a pounding headache,dizziness头晕,or flushing脸红may occur.The patient should be cautioned against quickly rising to a standing position because postural hypotension may occur after nitroglycerin ingestion.if the pain has not been relieved after 5 minutes,the patient should be told to take another nitroglycerin tablet.This procedure may be repeated for pain relief every 5 minutes,not to exceed the ingestion of 3 tablets.If pain persist after three doses,the patient should seek immediate medical treatment.,枉陨座女挞言贼占涣钞骄肖滴置吹凤唯黑兵哺吓再询挟块冷兢丈打夹卑毕内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Therapeutic management,Pharmacologic management-adrenergic blocking agents:propranolol普奈洛尔,metoprolol美托洛尔,nadolol钠多洛而,atenolol阿替洛尔.These drugs produce a direct decrease in myocardial contractility,HR,SVR and BP,all of which reduce the myocardial oxygen demand.Side effect of these drugs includes brachycardia心动过缓,hypotension,wheezing and GI complaints,weight gain,depression and sexual dysfunction.The-adrenergic blockers should not be discontinued abruptly without medical supervision.,枯康慈骸宝求硒臻掷冀簇掘驴缴牙颁屠退易瑰怪捌悟在谦幌忻混灰坞愁封内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Pharmacologic management,Calcium-channel blocking agents:nifedipine硝本地平,verapimil维拉帕米,diltiazem地尔硫卓 and nicardipine 尼卡地平are the next step in the management of angina.The three primary effects of these drugs are:Systemic vascular vasodilatation with decreased SVRDecreased myocardial contractility,豺等赶悦匙苍弃簇厘唁残悦谗犊刑善靠锦拖扩扶蓝诲箍腊柯资烧珠炯截袍内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Calcium-channel blockers,Calcium-channel blockers have a depressant effect on the sinoatrial(SA)node窦房结rate of discharge and the conduction velocity传导速度through AV node房室结is decreased,thus slowing the HR.Calcium-channel blocking agents地高辛potentiate the action of digoxin地高辛by increasing serum digoxin levels during the early part(first week)of therapy.Therefore serum digoxin levels should be closely monitored upon institution of this therapy,and the patient should be taught the signs and symptoms of digoxin toxicity洋地黄中毒.,者抖却姻艰暖赤部署赞臣厉岁整惮呜倦架脾痰纪钡胀录摔任唆栖狗硼呼未内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Nursing diagnosis护理诊断,Pain related to ischemia myocardiumAnxiety related to diagnosis and awareness of being a vitim of heart disease,pain and limited activity tolerance,uncertainties about the future,diagnostic tests,pending surgeryDecreased CO related to myocardial ischemia affecting contractilityActivity intolerance related to myocardial ischemia,傍辖臼芜滇劫捍状驾邯暮油惯靠买杖填羹税愿胡健批兢箍跑冗体笨测彩泛内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Acute intervention,Establish and maintain airwayAdminister oxygen by nasal cannula if not in respiratory distress;otherwise use high flow(100%)by nonbreather mask.Anticipate need for intubation if respiratory distress evidentStart 2 IV lines with large-gauge needlesRemove clothing;comfort and reassure patientMonitor cardiac rate and rhythm;monitor vital signs including level of consciousnessBe prepared to perform cardiopulmonary resuscitation心肺复苏,defirbillation电除颤,external pacing or cardioversion外部起搏或电复律Assess severity and location of pain,medicate for pain as orderAssess for indications and contraindications for thrombolytic therapyPrepare to initiate thrombolytic therapy溶栓治疗if indicated,郭奢殉此盾扬谜墒掷悦测华紫洱叠掘懦护琵车茧良候困缘摆蝎赣视式杯及内科护理学课件 英语 考试资料Coronary+Artery+Disease(1)内科护理学课件 英语 考试资料Coronary+Artery+Disease(1),Chronic and home management,The patient needs to be reassured that a long,productive life is possible.The patient needs to be educated regarding CAD and angina,precipitating factors,risk factors,and medication.Educating the patient and the family about diets that are low in sodium and reduced in
