Sweating in Myocardial Infarction System †MyAssignmenthelp.com

Question: Discuss about the Sweating in Myocardial Infarction System. Answer: Introduction: Common causes of myocardial infraction include smoking and alcohol consumption. Mr Savea is associated with both these factors responsible for the development of myocardial infraction. Risk factors responsible for the occurrence of myocardial infarction are old age, family history, high blood pressure, obesity, diabetes mellitus, increase in cholesterol and low density lipoprotein levels. Lack of exercise and stress also plays important role in the development of myocardial infraction. Approximately 35 % with smoking, 22 % with obesity, 10 % with lack of exercise and 4 % with stress, are prone to the development of myocardial infraction. Mr Savea is old person and having obesity, high cholesterol level and high blood pressure which are mainly responsible for the occurrence of myocardial infarction in Mr. Savea (Chong et al., 2011; Mehta et al., 2014). Myocardial infarction can lead to the development of stable angina. Angina is a condition with chest pain. This chest pain occurs due to the less supply of blood to heart muscle. Angina developed because myocardium couldnt meet its demand of blood supply. Mitral valve stenosis is responsible for the occurrence of systemic embolism which leads to the myocardial infarction (Cardoz et al. 2015). Currently 16.0 million people are associated with myocardial infarction worldwide. In US, approximately 1 million people have myocardial infarction each year. Myocardial infarction is the fifth most expensive hospitalization. Risk of death in patients with myocardial infarction is approximately 10 %. It has been observed that risk factors responsible for myocardial infarction are same in almost all the geographic regions and racial/ethnic groups. 1-5 numbers of cigarettes smoking per day can lead to the increase 42 % chances of myocardial infarction. Myocardial infarction can negatively affect j ob of Mr. Savea as he would not be able to attend his job. Myocardial infarction can also affect social and psychological aspects of Mr. Savea. Due to disease condition, Mr. Savea may feel socially isolated because he cant meet his friends and society members due to hospitalization. He can not take part in social activities also. Myocardial infarction can also have psychological effect on him. He may feel depressed and his moral might be down due to diseases condition. Myocardial infarction can also have significant financial impact on the family. There would be more spending on the treatment of Mr. Savea as compared to the earning. Moreover, as he could not attend his job, earning would also be less. Family members would always be in stress due to diseased condition (Valensi et al., 2011). Shortness of breath is another symptom of myocardial infraction. Shortness of breath occurs due to damage to heart and reduced output from the left ventricle. This results in the left ventricular failure and consequently pulmonary edema. Pulmonary edema results in the disturbance in the inhalation and exhalation of air. Reduced oxygen saturation may lead to the increased respiratory rate with short duration breathing, hence shortness of breath occurs in patients with myocardial infraction (Botker et al., 2016). Ischemic chest pain: Chest pain is the most significant symptoms of myocardial infraction. Chest pain mainly occurs due to the insufficient supply of blood to the myocardium. As a result, there is disturbed demand and supply of blood to the myocardium (Malik et al., 2013; Abed et al., 2015). Coma: Coma can occur due to insufficient blood supply to the brain. Due to inadequate blood supply to the brain, less amount oxygen supply to brain occurs. Due to this, there would be brain tissue death. As a result there would be brain dysfunction and occurrence of coma (Lu et al., 2015). Hyperhidrosis: In myocardial infarction hyperhidrosis occurs due to the increased firing of the sympathetic nervous system. Sympathetic nervous system is responsible for the fight or fligt response. Activation of the sympathetic nervous system leads to the stimulation of sweat glands which results in hyperhidrosis. Due to pain during myocardial infarction, there is increased release of hormones. This hormone release results in the faster heart rate and increased blood pressure, which results in the sweating. Hyperhidrosis is the good predictor of the ST-segment elevation myocardial infarction (STEMI) (Gokhroo et al., 2016). Lethargy: Lethargy occurs in patients with myocardial infarction due to insufficient supply of blood to the tissues. As a result, there is less metabolic activity in the cells and less ATP generation (Abed et al., 2015). Angiotensin converting enzyme inhibitors (ACE inhibitors) and beta-blocker drugs can be used for the treatment of myocardial infarction. Angiotensin-converting enzyme is the important component of the reninangiotensin system. ACE inhibitors block the conversion of angiotensin I (AI) to angiotensin II (AII). This result in the reduced arteriolar resistance, increased venous capacity, reduced cardiac output and volume and reduced resistance in blood vessels. Inhibition of this enzyme results in the dilatation of the blood vessels, reduced blood pressure and decreased demand of blood by the heart. ACE inhibitors also have central activity with stimulation of the parasympathetic nervous system activity in patients with myocardial infarction. ACE inhibitors can also reduce plasma norepinephrine levels and reduces its vasoconstriction effects. Most common examples of ACE inhibitors include zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril. Most common si de effects of ACE inhibitors include hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea, and renal impairment. ACE inhibitors should be started in the patients within 24 hour of myocardial infarction attack. ACE inhibitors are more useful in patients with ST elevation MI (STEMI) as compared to the non-ST elevation MI (NSTEMI). ACE inhibitors can also improve duration of survival of patients with myocardial infarction (Lubarsky and Coplan, 2007). Beta blockers are specifically useful for the prevention of second attack of myocardial infarction. Beta blockers act as competitive antagonist of the endogenous catecholamines like epinephrine and norepinephrine receptors on adrenergic beta receptors. Available beta blockers can block all beta adrenergic receptors and can block individual beta receptors like 1, 2 and 3 receptors. Bisoprolol, carvedilol, and sustained-release metoprolol are particularly useful as adjunct therapies for ACE inhibitors and diuretics in myocardial infarction (Bangalore et al., 2014). In addition to the 1 sympatholytic activity, beta blockers also act on the rennin-aniotensin system and decrease secretion of rennin. Beta blockers produce decreased oxygen demand by reducing heart rate, blood pressure and contractibility of the blood vessels and consequently ischemic chest pain relief. Beta blockers also produce reduced ventricular fibrillation by increasing ventricular fibrillation threshold (Kezerashvili et al., 2012). Beta blockers are also useful in reducing infract size and preventing development of definite infraction. Nursing strategies: Pain management: Nurse should monitor for the characteristic of pain in Mr. Savea He should verbalise his pain and also it should be collected through non-verbal cues. Pain should be assessed on scale of 0 to 10 and it should be compared with earlier episodes of pain. Pain should be characterized based on duration, intensity and radiation. Mr. Savea should be instructed to report pain immedietly and correctly. Mr. Savea should be provided with quiet and comfortable environment. He should be assisted in relaxation techniques like deep breathing and distraction from the pain. He should be administered with medications like antianginals like nitroglycerin, beta blockers like propranolol and analgesis like morphine (Harker et al., 2014; Carville et al., 2014). Anxiety and Activity intolerance: Mr. Saveas behavior like withdrawal and denial from tests and medication consumption should be noted. Verbal and non-verbal signs of anxiety should be noticed in Mr. Savea. Nurse should give him confidence of improvement in his condition, information about the routine procedures, and information about the medications. He should be taking into confidence prior to implementation of nursing intervention (Harker et al., 2014; Carville et al., 2014). Mr. Savea should increase his activity level in the graded manner. It includes getting up and sitting along with progressive ambulation. Nurse should monitor for the intolerance in activities and provide required intervention for the same (Oh et al., 2013). Cardiac output and tissue perfusion: Blood pressure should be assessed in both the arms and in different positions like lying, standing and sitting. Pulse rate and breathing rate should be recorded. Blood pressure and pulse rate should be recorded with respect to the different activities and appropriate rest should be provided. Light meal should be provided with the exclusion of caffeinated and carbonated drinks. Assessment should be done for cardiac output, ECG, chest X-ray and laboratory tests like cardiac enzymes, ABG (arterial blood gas) and electrolytes. Antidysrhythmic drugs treatment should be initiated. Mr. Savea should be assisted in the insertion of pacemaker (Oh et al., 2013). Nurse should monitor for sudden change in the anxiety, lethargy and confusion in Mr. Savea. Peripheral pulse rate should be monitored. Food consumption and urine output should be recorded. Erythema and edema should be monitored. Mr. Savea should be encouraged to perform leg exercise. Laboratory tests should be performed to evaluate ABGs, BUN, prothrombin time, creatinine, and electrolytes. Mr. Savea should be administered with anticoagulant and antacid drugs. After consultation with the doctor, nurse should order for reperfusion therapy in Mr. Savea (Anderson and Taylor, 2014). Fluid volume: Decrease in cardiac output should be noted and fluid balance should be calculated. Fluid intake should be maintained at 2000 mL/24 hr which is in the range of cardiovascular tolerance. Low sodium food and liquid should be administered with administration of the antidiuretic medication (Harker et al., 2014). Information about medication : Nurse should assess his knowledge about the disease and medications. Based on his level of knowledge, nurse should educate him about disease pathology, symptoms and medications. Nurse should also give information about the risk factors, dietary requirements and symptoms which require immediate attention. He should keep himself away from triggering factors like alcohol and smoking. Nurse should educate him to reduce body weight (Oh et al., 2013; Anderson and Taylor, 2014). References: Abed, M.A., Ali, R.M., AbuRas, M.M., Hamdallah, F.O., Khalil, A.A., and Moser, D.K. (2015). Symptoms of acute myocardial infarction: A correlational study of the discrepancy between patients' expectations and experiences. International Journal of Nursing Studies, 52(10), 1591-9. Anderson, L., and Taylor, R.S. (2014). 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