T ASA G LOBAL DE F ECUNDIDAD
4. Nivel de educación y analfabetismo
4.1. Población en edad escolar
Following successful conversion to a perfusing rhythm, the patient may be hemodynamically unstable and require continuous intensive monitor- ing. Vasoconstrictors may be administered to main- tain an adequate blood pressure. If the patient was placed on a transcutaneous pacemaker during the cardiopulmonary arrest, then a transvenous pace- maker may need to be inserted until a permanent pacemaker can be placed.
Induced therapeutic hypothermia (32° to 34°
Celsuis) may benefi t unconscious adult patients who experience out-of-hospital cardiac arrest due to ven- tricular fi brillation and who are resuscitated in the fi eld. In addition, there is evidence that supports
C A S E S T U D Y
M
r. B. was being cared for in the critical care unit following an acute myocardial infarction. He presented to the emergency department complain- ing of “heaviness” in his chest. He was diaphoretic and dyspneic. The initial 12-lead ECG revealed ST-segment elevation in leads I, aVL, and V1 through V5, with signifi cant Q waves in V1 throughV4.Mr. B. is admitted to the critical care unit fol- lowing cardiac catheterization for angioplasty and placement of drug-eluting stents. He is kept in a supine position with his leg straight. Initial assess- ment of the groin access site reveals an intact, dry dressing, and no swelling or hematoma. Mr. B. is awake, oriented, and cooperative.
Three hours following the cardiac catheteriza- tion procedure, Mr. B. develops some swelling at the groin site and pressure is applied. At this time, Mr. B. is awake, alert, and cooperative, but an hour later, he becomes restless and agitated and com- plains of low back pain. He is thrashing around in the bed and will not remain supine. The nurse pages the physician and requests that he come to the bedside urgently. Mr. B. is becoming progres- sively more combative, and suddenly he loses consciousness. A code is called and the code team responds with the crash cart to the bedside.
The nurse quickly assesses Mr. B. and fi nds that he is not breathing. A manual resuscitation bag (MRB) is used to ventilate Mr. B after open- ing the airway with a head tilt. The cardiac monitor shows a rhythm, but no pulse is palpable. Chest compressions are started immediately. Another nurse assesses pulses during chest compressions to assure adequate compressions. A nurse anes- thetist intubates Mr. B., and a respiratory therapist maintains ventilation.
The responding physician orders laboratory studies and the administration of IV fl uid boluses and ACLS medications. Mr. B. is noted to have pulseless electrical activity and potential underlying causes are managed. Mr. B. dies following multiple attempts to reestablish a perfusing rhythm.
1. Why did the nurse call the physician to the bed- side when Mr. B. became agitated?
2. How should the nurse performing cardiopul- monary resuscitation (CPR) deliver chest compressions?
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R e f e r e n c e s
1. Jones D, Bellomo R, Goldsmith D: General principles of medical emergency teams. In DeVita MA, Hillman K, Bellomo R (eds): Medical Emergency Teams:
Implementation and Outcome Measurement. New York, NY: Springer Press, 2006, pp 80–90
2. Butner S: Rapid response team effectiveness. Dimens Crit Care Nurs 30(4):201–205, 2011
3. American Heart Association: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122(18), 2010
4. Holzer M, et al: Targeted temperature management of car- diac arrest. N Engl J Med 363:1256–1264, 2010
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THREE
C H A P T E R
Patient Assessment:
Cardiovascular System
12
Cardiovascular System
Based on the content in this chapter, the reader should be able to:
1 Describe the components of the history for cardiovascular assessment.
2 Explain the use of inspection, palpation, percussion, and auscultation for cardiovascular assessment.
3 Discuss the mechanisms responsible for the production of the fi rst, second, third, and fourth heart sounds and their timing in the cardiac cycle.
4 Describe the attributes of common systolic and diastolic murmurs.
5 Discuss the use of routine blood tests, serum lipid levels, and biochemical markers in the diagnosis and monitoring of cardiovascular disease.
6 Discuss the purpose of cardiovascular diagnostic studies and associated
nursing implications.
O B J E C T I V E S
A
lthough advanced and complex technologiesare being used with increasing frequency to assess and manage cardiovascular conditions, a compre- hensive history and physical examination is also an integral part of care for critically ill patients with cardiovascular conditions.
History
The cardiovascular history provides information that guides the physical assessment, the selection of diagnostic tests, and the choice of treatment options.
Elements of the cardiovascular history are summa- rized in Box 12-1.
The nurse begins the history by investigating the patient’s chief complaint. Obtaining answers to the questions posed in Box 12-2 helps the nurse to bet- ter understand the nature of the patient’s signs and symptoms, and may provide clues to the underlying cause. Chest pain, one of the most common symp- toms of cardiovascular disease, is commonly caused by coronary artery disease (CAD). Chest pain may also be secondary to cardiovascular problems that are unrelated to CAD (eg, pericarditis). Differential diag- noses of chest pain are summarized in Table 12-1.
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