In the acute period of the disease, the patient needs constant medical supervision. Most medications used in the treatment of myocardial infarction can only be used in a hospital under the supervision of a doctor and laboratory blood monitoring. In addition, the course of the disease can be complicated by such life-threatening conditions as cardiac arrhythmias, acute heart failure and other pathologies, in which it is necessary to urgently hospitalize the patient in the intensive care unit.

Since myocardial infarction is one of the most dangerous diseases of the cardiovascular system, even after the pain has passed, a person requires special care, which is carried out even at home under the supervision of a doctor.

There are several periods during the course of the disease. The acute period of myocardial infarction usually lasts about 2 weeks. At this time, the heart is just beginning to recover and is completely unable to cope with stress. That is why the most important thing for a person who has suffered a myocardial infarction is complete rest. In this case, the patient must be under the supervision of a doctor and observe bed rest. Since all active movements are contraindicated during this period, the patient needs to be helped to turn over in bed for the first few days, since even such a small physical activity can cause a deterioration in the condition. During this period, it is necessary to monitor the patient’s pulse rate, feed and water him, regularly measure blood pressure, and carry out all hygienic procedures in bed. Any changes in the patient's condition should be reported to the attending physician immediately, as they may be the first sign of worsening of the disease.

Particular attention should be paid to intestinal function. Painkillers and bed rest often cause constipation. The patient begins to push, tenses up, and as a result the heart experiences increased load. It is important to ensure that bowel movements occur regularly, preferably every day, but at least once every 2 days. If there is no independent bowel movement, laxatives or a cleansing enema should be used only on the recommendation of a doctor.

After myocardial infarction, the patient is forced for a long time lie almost motionless. This can cause blood clots to form in the veins of the legs. Even slight compression of the veins causes disruption of blood flow, which may result in a blood clot. Therefore, already on the second day after a heart attack, it is necessary to slightly raise the patient’s legs, placing a small pillow or a rolled blanket under the knees.

Strict bed rest can also cause bedsores. It is necessary to carefully examine the patient’s skin every day and carefully care for it (massage, antiseptic solutions(potassium permanganate), irritants to improve blood circulation - 2% alcohol solution of camphor).

Nervous stress is no less dangerous for the patient than physical stress. Any experience, be it fear, grief or good news, can cause a recurrent myocardial infarction! A sick person needs to be protected as much as possible from the outside world until his heart gets stronger. A sharp loud sound in the corridor or on the street can greatly frighten him, causing serious complications. All relatives should be warned to avoid talking about events that may agitate the patient. It is also recommended to instill in the patient faith in a favorable outcome of the disease.

Particular attention should be paid to older people. Some of them often do not realize how important it is to strictly follow the doctor's orders. They may not take any medications, thinking that they are no longer needed, or simply forget to take them, and also start taking some of their own pills that they were treated with before or that were recommended by friends or relatives. It is important to ensure that there are no additional items in the patient’s bedside table. medicines, except those prescribed by the attending physician; and also ensure that the patient takes all necessary medications.

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According to statistics from the World Health Organization, heart disease is one of the most common causes of death. Among them are cardiosclerosis and angina pectoris, but myocardial infarction remains the priority.

During the latter, the patient’s blood supply to the heart muscle is disrupted, which causes necrosis. Due to partial tissue death, the organ cannot function as before: this is fraught, first of all, with the development of severe cardiac ailments.

Most often, a heart attack occurs suddenly. The person’s condition is so critical that he cannot survive without emergency help. Medic in mandatory must stabilize the patient’s condition before doctors arrive and monitor the patient’s health during rehabilitation therapy in the hospital or at home.

The first hours after an attack are the period when the highest percentage of deaths is observed. The nursing process during myocardial infarction involves stabilizing the patient's condition and gradually removing him from a critical condition.

The health care worker must make every effort to slow down tissue necrosis. To this end, he must:

The main goal of the nurse after doctors restore blood supply to the patient’s heart is to monitor the patient’s vital signs. Regular measurement of pulse, blood pressure and heart rate helps to avoid complications.

The nurse is also entrusted with the functions of explaining to the patient the characteristics of his cardiac diseases, familiarizing his loved ones with the first signs and complications of myocardial infarction. This will allow relatives to recognize the disease in time and provide first aid.

An employee of a medical institution is also obliged to explain to the patient how the drugs prescribed by the doctor affect the treatment of the disease and help reduce risks.

Pre-hospital emergency measures

It often happens that a heart attack occurs in a medical facility when a person is being treated for cardiac or other pathologies. Competent nursing care is what can save a person’s life. To provide first aid, you need to know a certain algorithm of actions:

Call a doctor and provide a detailed description of the patient’s symptoms.
Proper placement of the patient on the pillow - it should be elevated.
Remove outer clothing and provide fresh air.
Calming the patient if he begins to panic.
Systematic (every 5-7 minutes) measurement of blood pressure and pulse.
Warming the upper and lower extremities.
Applying mustard plaster to the sternum.

To thin the blood, the patient should be given Aspirin, and to relieve pain - Nitroglycerin. If possible, the patient is given up to 10 cubes of Heparin intravenously: this substance prevents the formation of blood clots.

Sometimes victims are given fibrinolytics (Fibrinolysin, Streptokinase) - this is a group of drugs that make it possible to slow down or completely avoid the death of heart tissue. Such medications are contraindicated in patients with impaired blood clotting and cancer.

If the patient has lost consciousness, it is necessary to perform chest compressions and artificial respiration. A person must be resuscitated until he begins to breathe on his own. If this does not happen, resuscitation measures must be carried out until the ambulance arrives.

Observation in hospital

After stabilization of the patient's condition, the patient is admitted to the hospital. Despite the extent and severity of a heart attack, a person needs careful care and rehabilitation. The nurse's job at this stage is to:

Patient care also involves massage of the lower and upper extremities. This allows you to maintain muscle tone during a period when a person is prohibited from moving.

Patients who feel better are allowed to sit. The patient can spend no more than a quarter of an hour a day in this position.

Outpatient

Some patients are allowed to undergo rehabilitation therapy at home. In this case, the health worker talks in detail about all the medications prescribed to the person. The hospital employee is required to report how each medication affects the human body, the dosages of the drugs, their absorption time and the consequences in case of an overdose.

To improve the patient's condition, the nurse must, among other things:

A health care provider should also talk about the benefits of physical activity. The patient can study at home or attend specialized classes. Thanks to sports, rehabilitation will be faster.

The nurse carries out the same actions if the patient is discharged.

Typical problems and solutions

While undergoing rehabilitation, a person who has suffered a disruption of blood flow in the heart muscle is still at risk. Due to the fact that the heart muscle does not function fully, the patient may experience the following complications:

pericarditis;
heart failure;
angina pectoris;
thromboendocarditis.

In addition, most patients experience heart rhythm disturbances. Other complications after a heart rupture include tachycardia, chest pain and panic attacks. Each of these ailments can appear within six months after a heart attack.

In any of the situations, the patient must contact either a nurse or a cardiologist. The doctor, having examined the patient and carried out the necessary examinations, will develop an additional treatment plan for him.

These diseases can be avoided or prevented by following a diet and maintaining blood pressure and heart rate. Don’t forget about playing sports: physical activity should be moderate.

Myocardial infarction – dangerous condition, which does not endure for a minute. In such situations, responsibility for the patient's life falls on the shoulders of the nurse. She must first call an ambulance and stabilize the patient's condition.

Once the patient is in the hospital, the nurse should monitor his rehabilitation, explaining the importance of each stage of recovery. Care from medical staff and constant consultations with the patient will help him recover faster.

However, the recovery time after a heart attack depends on the patient himself. If he follows a diet, forgets about alcohol, smoking and stress, and begins a course of physical therapy, then rehabilitation will take much less time.

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Federal State Budgetary Educational Institution

secondary vocational education

"Medical College"

Administration of the President of the Russian Federation

Coursework

Features of nursing care for myocardial infarction

Completed:

student of the "Nursing" department

3 courses, group "L"

Makarova Anastasia

Responsible manager (chief m/s):

Immediate supervisor (senior m/s):

Curator (college teacher):

Rogacheva T.A.

Moscow 2015

1. Goals and objectives

1.1 Goals

1.2 Objectives

2. Myocardial infarction

2.1 Etiology

2.2 Pathogenesis

2.3 Diagnostics

2.4 Clinic

2.5 Treatment

2.6 Care

Conclusion

1. Goals and objectives

1.1 Goals

· Monitor the course of myocardial infarction in a patient with myocardial infarction.

· Study the features of drug treatment, exercise therapy and physical therapy.

1.2 Objectives

1. Study the patient with a diagnosis of myocardial infarction.

2. Write down the main signs of this disease.

3. Identify the characteristics of the course of the disease, depending on gender, age, working conditions, etc.

4. Justify medical care for the patient.

2. Myocardial infarction

Myocardial infarction is an acute condition, a clinical form of coronary heart disease, in which, as a result of complete or partial insufficiency of blood supply to an area of the heart muscle, its necrosis (death) develops. This leads to disruptions in the functioning of the entire cardiovascular system and threatens the life of the patient.

The main and most common cause of myocardial infarction is a violation of blood flow in the coronary arteries, which supply the heart muscle with blood and, accordingly, oxygen. Most often, this disorder occurs against the background of atherosclerosis of the arteries, in which atherosclerotic plaques form on the walls of blood vessels. These plaques narrow the lumen of the coronary arteries and can also contribute to the destruction of vessel walls, which creates additional conditions for the formation of blood clots and arterial stenosis.

2.1 Etiology

Myocardial infarction develops as a result of obstruction of the lumen of the vessel supplying the myocardium (coronary artery). The reasons may be (by frequency of occurrence):

Atherosclerosis of the coronary arteries (thrombosis, plaque obstruction) 93-98%

· Surgical obturation (artery ligation or dissection during angioplasty)

· Embolization coronary artery(thrombosis due to coagulopathy, fat embolism, etc.)

Spasm of the coronary arteries

Separately, a heart attack is distinguished with heart defects (abnormal origin of the coronary arteries from the aorta).

2.2 Pathogenesis

There are stages:

Damage (necrobiosis)

Necrosis

Scarring

Ischemia can be a predictor of heart attack and last for quite a long time. The process is based on a violation of myocardial hemodynamics. Usually, a narrowing of the lumen of the cardiac artery to such an extent that the restriction of blood supply to the myocardium can no longer be compensated is considered clinically significant. Most often this occurs when the artery narrows by 70% of its cross-sectional area. When compensatory mechanisms are exhausted, they speak of damage, then the metabolism and function of the myocardium suffer. The changes may be reversible (ischemia). The damage stage lasts from 4 to 7 hours. Necrosis is characterized by irreversible damage. 1-2 weeks after a heart attack, the necrotic area begins to be replaced by scar tissue. The final formation of the scar occurs after 1-2 months.

2.3 Diagnostics

The main and most common symptom typical of myocardial infarction is a pain attack in the chest area. The pain increases, can be pulsating, radiating to the arms, back, shoulder blades. Typically, if it is repetitive painful sensations, then each time they become more and more pronounced during myocardial infarction. The attack lasts for a long time- about 20-40 minutes, while the pain does not subside when taking nitroglycerin and changing body position.

A series of general questions to help you initial stages recognize myocardial infarction:

· time of onset of the attack and its duration;

· whether drugs were taken to suppress pain, whether they had a positive result;

· does the pain change depending on the position of the body, when standing up, sitting, lying down, when walking, when breathing changes;

· the frequency of such painful attacks and their intensity, in case of repeated repetition.

In some cases, the attack passes without significant symptoms and the diagnosis of myocardial infarction becomes more complicated. Patients with diabetes are more likely to experience shortness of breath, pain when walking, and signs of heart failure. Placing a patient in a hospital allows you to obtain more accurate information and prescribe further treatment.

Electrocardiography

The main method for diagnosing myocardial infarction is an electrocardiographic study. Pay attention to the height of the pointed T waves; during a heart attack, they are usually high, and an increase in the level of the ST segment by 1 mm also indicates the presence of a necrotic process. Taking ECG data during cardiac pacing is accompanied by temporary switching of the stimulator. A lower frequency makes it possible to observe the curve against the background of the heart’s own rhythm. Analysis of ECG data allows us to assess the location of myocardial tissue damage, the extent of its spread and the time frame from the beginning of cell destruction. For a reliable and correct assessment when diagnosing myocardial infarction, ECG data should be updated every 25-30 minutes, for comparison with previously conducted studies, in order to be able to see the dynamics of the spread and nature of the disease. Based on the obtained tests, an accurate diagnosis of myocardial infarction is made and appropriate treatment is carried out.

Biochemical parameters, general blood test

Accurate diagnosis of myocardial infarction is impossible without special blood tests. The number of neutrophil leukocytes increases during the first and second days; on the third day, the level of leukocytes reaches its highest point and drops to a normal number, while the ESR increases. This is associated with the occurrence of inflammatory processes and scar formation. Also, at first there is an increase in enzymatic activity in myocardial tissues. The appearance in the blood serum of markers indicating necrotic changes in the muscles of the heart suggests myocardial infarction. Troponin, a contractile protein, is not normally found in blood serum, but is always present during myocardial infarction. heart attack patient nursing care

Echocardiography

This diagnostic method is used for additional information in case of an unclear picture of ECG readings. Research using echocardiography, ultrasound examination makes it possible to identify hidden coronary heart disease, angina pectoris and exclude myocardial infarction.

Radiography

A chest x-ray will show possible pulmonary congestion as one of the signs of a complication of myocardial infarction.

A patient with suspected myocardial infarction should be given emergency care and immediately admitted to hospital for further observation and treatment.

2.4 Clinic

The main clinical sign is intense chest pain (anginal pain). However, pain sensations can be variable. The patient may complain of discomfort in the chest, pain in the abdomen, throat, arm, or shoulder blade. Often the disease is painless, which is typical for patients with diabetes.

The pain syndrome persists for more than 15 minutes (can last 1 hour) and stops after a few hours, or after use narcotic analgesics nitrates are ineffective. There is profuse sweat.

In 20-30% of cases with large-focal lesions, signs of heart failure develop. Patients report shortness of breath and nonproductive cough.

Arrhythmias are common. As a rule, these are various forms of extrasystoles or atrial fibrillation. Often the only symptom of a myocardial infarction is sudden cardiac arrest.

The predisposing factor is physical activity, psycho-emotional stress, fatigue, hypertensive crisis.

2.5 Treatment

If a myocardial infarction is suspected, the patient is first seated and reassured. A sitting position is recommended, preferably on a chair with a backrest, or reclining with knees bent. Tight, disturbing clothes are unbuttoned and the tie is loosened.

If a patient is prescribed a medicine for chest pain, such as nitroglycerin, and this medicine is on hand, then the patient is given this medicine.

If the pain does not go away within 3 minutes after sitting at rest or after taking nitroglycerin, call an ambulance without delay. First aid providers should not succumb to the patient’s persuasion that everything will pass now. If the ambulance cannot arrive quickly, the patient is taken to the hospital in a passing car. In this case, it is advisable for two healthy people to be in the car, so that one drives the car and the other monitors the patient’s condition.

If aspirin is on hand, and the patient does not have a known allergy to aspirin, then he is given 300 mg of aspirin to chew. If the patient constantly takes aspirin, the dose taken that day is supplemented to 300 mg. It is important to chew the tablets, otherwise the aspirin will not work quickly enough.

In case of cardiac arrest (loss of consciousness, absent or agonal breathing), cardiopulmonary resuscitation is started immediately. Its use greatly increases the patient's chances of survival. The use of portable defibrillators further increases survival rates: being in public place(café, airport, etc.), first aid providers should ask the staff if they have or have a defibrillator nearby. Pulseless detection is no longer a necessary condition To begin resuscitation, loss of consciousness and lack of rhythmic breathing are sufficient.

Of great importance in the treatment of a patient with acute myocardial infarction is proper care. Staying in bed for quite a long time helps slow blood circulation in the peripheral parts of the vascular system. In addition, a decrease in the contractile function of the heart also leads to disruption of active blood circulation.

To prevent the development of bedsores, it is necessary to regularly wipe the patient’s skin with camphor alcohol diluted with cologne, and then wipe with a dry towel. In the first days of illness, a bed is placed on the patient to perform the act of defecation, after which they rinse with warm water. A urine bag is provided for urination.

A patient with a heart attack is prescribed diet No. 10 and fed in bed. To change linen, the patient is carefully turned in bed, and to prevent the development venous thrombosis Turn from side to side 3 times a day. During this procedure, the patient should not make sudden movements or strain.

The patient should get out of bed gradually. At first he sits down with the help of a nurse, and after a few days he gets up. In this case, you need to monitor your pulse and blood pressure.

Conclusion

Myocardial infarction is a serious disease. Our responsibilities include both physical and moral assistance to a patient with this disease. Timely diagnosis of the disease can prevent serious deterioration in the patient’s health.

Properly selected medications help patients recover faster.

Caring for seriously ill patients helps prevent bedsores.

List of used literature

1. Sorokina T.S.: History of medicine. - M.: Academy, 2009

2. Smoleva E.V.: Nursing in therapy with a course of primary medical care. - Rostov n/a: Phoenix, 2010

3. ed. A.G. Chizha: Manipulations in nursing. - Rostov n/a: Phoenix, 2009

4. https://ru.wikipedia.org

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...

Nursing process in myocardial infarction (essay, coursework, diploma, test)

INTRODUCTION Relevance of the study. Coronary heart disease (CHD) is one of the main human diseases, significantly worsening the quality of life and leading to death. Statistical research indicate that more than 50% of the population over the age of 65 suffer from cardiovascular diseases. In Russia, according to different authors, annually, coronary heart disease is diagnosed in 2.8−5.8 million people, and the mortality rate is up to 30% of the total.

Acute myocardial infarction (AMI) is a disease that can result in the patient’s recovery without the intervention of doctors, and vice versa, lead to death, despite all their efforts. However, between these extremes there is a large group of patients whose fate depends on the timely intervention of a doctor and the use of modern treatment methods.

The most dangerous is the early phase of the disease - the first hours, when the risk of cardiac arrest is high. Timely and adequate medical care for AMI consists of performing the thrombolysis procedure as early as possible, optimally within the first hour from the onset of symptoms. The patient should be hospitalized in a cardiac intensive care unit with the ability to perform angioplasty and stenting of the coronary arteries. The sooner blood flow in the vessel is restored, the greater the chance of a favorable outcome. Meanwhile, if the symptoms of the disease are not severe or atypical, several hours may pass before the patient seeks help.

The object of the study is acute myocardial infarction, as an independent nosological unit and patients with acute myocardial infarction.

The purpose of the study is to study as fully as possible the theoretical foundations of acute myocardial infarction, the role of nursing care and diagnostic, treatment, and rehabilitation measures for myocardial infarction. The main objective of the study is

1. consider new methods in providing treatment and nursing care for AMI. Also show the need for thrombolytic therapy in the first hours of the disease.

2. consider the main risk factors for myocardial infarction

3. consider the clinical picture and complication

4. reveal the principles of primary medical care at home and in the hospital for myocardial infarction

5. describe the methods of examination and preparation for them

6. consider therapeutic and preventive measures

CHAPTER 1. THEORETICAL PART

1.1 Definition, etiology and pathogenesis of myocardial infarction Myocardial infarction is an emergency condition caused by a violation of the innervation of muscle areas, as a result of which the blood circulation of the heart is disrupted, causing the death of heart cells, while forming necrosis

1.2 Etiology and pathogenesis Myocardial infarction can be considered as a complication of various diseases accompanied by acute coronary insufficiency. Blockage of a coronary artery by a thrombus (coronary thrombosis) or embolism is possible with endocarditis, with some heart defects complicated by intracavitary thrombosis, with coronaritis, in particular with systemic arteritis, etc. Myocardial infarction most often develops in patients with atherosclerosis of the coronary arteries, significantly affecting the prognosis for the life and ability to work of people with this very common pathology. On this basis, in modern classifications, myocardial infarction is considered as an independent disease - an acute and most severe form of coronary heart disease.

Necrosis of an area of the heart muscle during myocardial infarction is always caused by hypoxia resulting from ischemia due to cessation of blood flow through the artery supplying blood to this area. In most cases, the pathogenesis of arterial blockage coincides with the pathogenesis of vessel thrombosis on the ulcerated surface of a fibrous atherosclerotic plaque. It is not always possible to establish what external factors led to the development of myocardial infarction in a particular patient. In some cases, myocardial infarction develops after extreme physical or psycho-emotional stress. In both cases, its occurrence is facilitated by increased work of the heart and the release of adrenal hormones into the blood, accompanied by activation of blood clotting processes. As the work of the heart increases, the need of the heart muscle for oxygen increases, and the turbulent movement of blood in the area of the existing atherosclerotic plaque and increased blood clotting contribute to the formation of a blood clot in the area of narrowing of the artery, especially if the surface of the atherosclerotic plaque is ulcerated.

Absorption of products of necrotic myocardium into the blood, which are perceived by the immune system as a foreign protein, can cause the formation of autoantibodies and the development of an autoimmune reaction in the form of the so-called. post-infarction syndrome.

1.3 Development of myocardial infarction

IN is always accompanied by a violation of the pumping function of the heart. If myocardial necrosis is very extensive, it can cause acute left ventricular heart failure, cardiogenic shock, and death within minutes to hours after cessation of coronary artery flow. Most often sudden death acute stage the disease occurs from ventricular fibrillation. Pathogenetic prerequisites for the appearance of various arrhythmias during myocardial infarction arise due to a violation of the sequence of excitation propagation throughout the myocardium (excitation does not spread through necrotic areas). In addition, the electrical instability of the myocardium around the necrosis zone contributes to the emergence of foci of spontaneous excitation here, which serve as sources of extrasystole, paroxysmal ventricular tachycardia, and ventricular fibrillation.

1.4 Pathological anatomy of myocardial infarction

In the vast majority of cases, myocardial infarction is found in the left ventricle of the heart. If the patient’s death occurred several hours or days after the cessation of blood flow through the coronary artery, then a zone of ischemic necrosis with irregular outlines and hemorrhages along the periphery is clearly visible in the myocardium. Microscopically, foci of destruction of muscle fibers are detected, surrounded by accumulations of leukocytes. From the fourth day of the disease, fibroblasts appear in areas of necrosis - parent cells connective tissue which is gradually developing. forming at first a tender scar, and by the end of the 2nd month of the disease a dense scar. Scar formation is completely completed after about 6 months. from the onset of the disease - post-infarction cardiosclerosis. Necrosis may involve the entire thickness of the myocardium at the affected site (transmural infarction) or may be located closer to the endocardium or epicardium; isolated infarctions of the interventricular septum of the papillary muscles are possible. If necrosis extends to the pericardium, there are signs of fibrinous pericarditis. Blood clots are sometimes detected in damaged areas of the endocardium, which can cause arterial embolism great circle blood circulation With extensive transmural myocardial infarction, the heart wall in the affected area is often stretched, which indicates the formation of a cardiac aneurysm. Due to the fragility of the necrotic heart muscle in the infarction zone, it may rupture; in such cases, massive hemorrhage into the pericardial cavity or perforation (perforation) of the interventricular septum is detected.

Factors contributing to the pathological process are

1. lack of exercise and poor nutrition

2. lack of oxygen in the blood

3. psychological, emotional, physiological strong stress. experiences, fear, grief.

4. alcohol abuse, smoking, drug addiction The most common cause is cholesterol plaques that are located in the coronary vessels and are attached to the walls. At the same time, it grows and at some time breaks off, an intravascular fissure is formed, where platelets and some fat cells are attached, where the formed thrombus grows. and closes the coronary lumen. in this case, there is no access of oxygen to the heart muscles, which leads to disruption of the heart and muscle tissue, resulting in necrosis of the heart muscle. CLASSIFICATION OF MYOCARDIAL INFARCTION

1. in depth:

1.1. transmural - this is when necrosis of the heart wall is extensive

1.2. finely focal

2. according to the clinical course:

2.1. not complicated

2.2. complicated

3. according to the forms of myocardial infarction

3.1. asthmatic variant

3.2. abdominal option

3.3. arrhythmic variant

3.4. cerebral variant

4. by complication

4.1. extrasystolic arrhythmia

4.2. sinus arrhythmia

4.3. atrial fibrillation

4.4.arrhythmic shock

4.5. cardiac shock

4.6. acute heart failure

4.7. heart aneurysm

4.8. ventricular septal rupture

4.9 topanade

1.5 Clinical symptoms and the course of myocardial infarction, precursors of myocardial infarction

1. persistently high blood pressure

2. swelling on the legs in the evening

3. cold profuse sweat on the face

4. dizziness and fainting

5. nausea and sometimes vomiting

6. pain in the chest area radiating to the left arm, leg, shoulder, patina, neck, lower jaw, sometimes pain in the back and abdomen (which is relieved first with validol and nitroglycerin.

Acute myocardial infarction is usually preceded by angina of varying duration, to which, shortly before the development of myocardial infarction, often acquires a progressive character: its attacks become more frequent, their duration increases, and they are poorly controlled by nitroglycerin. In some cases, myocardial infarction develops suddenly in patients without clinically manifested heart disease. However, careful questioning often makes it possible in such cases to establish that a few days before myocardial infarction the patient’s well-being worsened: it was noted fatigue, weakness, decreased mood, vague unpleasant sensations in the chest (discomfort).

Objectively: pallor of the skin with cold profuse sticky sweat on the face, cyanosis of the lips, shortness of breath with little physical activity or rest. Percussion: the left border of the heart is enlarged. Auscultation: weakening of 1 or 2 tones, weak systolic murmur, palpitations, sometimes galloping sounds are heard. a fever appears, which lasts for 3 days; temperature is 37−38; in the general clinical analysis, leukocytosis is detected, which lasts for 7 days; 10−12*10 per liter of blood, accelerated ESR,

ABOUT strict period, which is divided into main forms

1. abdominal form. proceeds according to the type of gastrointestinal tract pathology with pain in the pancreas, in the abdomen, with nausea and vomiting. Most often, the gastralgic form of myocardial infarction occurs with an infarction of the posterior wall of the left ventricle.

2. asthmatic form: begins with cardiac asthma and provokes pulmonary edema as an outcome. pain may absent. the asthmatic form is more common in older people with cardiosclerosis or with repeated heart attacks, or with very large heart attacks

3. arrhythmic form, the main symptom is paroxysmal tachycardia, pain syndrome may be absent

4. cerebrovascular- accompanied by fainting and stroke

5. extracardiac form - pain begins from the right half of the thoracic region, on the right arm, shoulder blade, moving to the left arm, shoulder, shoulder blade, back, lower and upper jaw, but no pain in the left half of the chest

6. asymptomatic - proceeds quietly and without noticeable results in mortality

A myocardial infarction is also divided into periods

1 pain or ischemic period is 2 days. The patient has a heart rhythm disturbance, a drop in blood pressure, a fever on the third day, and changes in blood tests. The patient always needs rest and bed rest. Objectively, during this period one can find an increase and then a decrease in blood pressure, an increase in heart rate, and during auscultation a pathological 4th sound is sometimes heard: biochemical changes in the blood practically appear, and there are also characteristic features in ECG change

The 2nd period is acute (febrile inflammation) characterized by the occurrence of necrosis of the heart muscle at the site of ischemia. signs of aseptic inflammation appear, hydrolysis products of necrotic masses begin to be absorbed. the pain usually goes away. the duration of the acute period is 10 days. the patient’s well-being gradually improves, but general weakness, malaise, tachycardia, and muffled heart sounds persist. increase in body temperature due to the inflammatory process in the myocardium, usually small up to 38

The 3rd subacute period is 2 weeks, the scars on the heart begin to heal slowly, the necrosis disappears. the heart begins to work at full strength. the patient is transferred to semi-bed rest with a minimum amount of load

The 4th period, the post-infarction period, lasts six months and is observed by specialists. At this time, it is necessary to avoid physical activity and emotional stress. all measures are being taken to prevent recurrent attacks and heart attacks

Conclusion: with the clinical picture I described, myocardial infarction with a high degree of probability suggests the presence of necrosis of the heart muscle or thrombosis of the coronary arteries, myocardial infarction in a middle-aged and elderly man is more symptomatic than in a woman, which leads to 5% disability and sudden death. in our time, the clinical picture is clearly expressed and does not change over the years, but the structure of the age line changes with a shift towards affecting the more middle-aged generation of people. Therefore, it is necessary to think about the development of growth with myocardial infarction. So, if all symptoms of pain completely disappear, then shortness of breath, severe weakness, depressed mood and chest discomfort are present during physical activity

Complications of myocardial infarction

The most serious complications in the acute period of myocardial infarction are cardiogenic shock, acute heart failure, manifested as cardiac asthma, pulmonary edema, rupture of the necrotic wall of the ventricle of the heart.

Cardiogenic shock is manifested by a sharp drop in systolic blood pressure - below 90 mm Hg. Art. and symptoms of severe peripheral circulatory disorders. The patient's appearance is characteristic: the skin is pale, with a grayish-bluish tint, facial features are pointed, the face is covered with cold sticky sweat, saphenous veins collapse and are not distinguishable upon examination. The patient's hands and feet are cold to the touch. The pulse is threadlike. Heart sounds are dull, at the apex of the heart the second sound is louder than the first. Urine is not separated or almost not separated. The patient is initially inhibited and later falls into an unconscious state.

Cardiac asthma and pulmonary edema are a manifestation of acute left ventricular heart failure, which in myocardial infarction is most often caused by a decrease in the contractile function of the myocardium of the affected left ventricle, and in some cases is associated with acute mitral insufficiency due to infarction of the papillary muscle. Characterized by increasing shortness of breath, turning into suffocation, a cough appears, first dry, then with more and more abundant foamy, often pink sputum, moist rales are heard, initially over individual areas of the lungs, mostly fine-bubble, then, as pulmonary edema develops, they become profuse, medium- and large-bubble , audible at a distance. The patient strives to assume a sitting position (orthopnea); Not only the intercostal muscles and abdominal muscles begin to take part in the respiratory act, but also the facial muscles of the face; the wings of the nose swell; the patient swallows air with an open mouth. Rupture of the ventricular wall and associated cardiac tamponade in the vast majority of cases leads to death within a few minutes.

Rupture of the necrotic interventricular septum causes severe pulmonary hypertension and right ventricular failure. It is characterized by the sudden onset of transverse systolic or systolic-diastolic murmur to the right and left of the sternum, reminiscent of a murmur due to a congenital defect of the interventricular sac.

Disturbances in the rhythm and conduction of the heart during myocardial infarction are extremely varied. Most often, ventricular extrasystole of varying severity is observed, which can develop into ventricular tachycardia and ventricular fibrillation. Atrial rhythm disturbances are less commonly recorded: extrasystole, paroxysmal tachycardia, atrial fibrillation. Atrial arrhythmias, unlike ventricular arrhythmias, are usually not life-threatening. Among conduction disorders associated with necrosis in the area of the cardiac conduction tract, the greatest danger is atrioventricular block.

A frequent complication of extensive myocardial infarction, especially localized in the anterior wall of the left ventricle, is a cardiac aneurysm, the development of which contributes to the occurrence of arrhythmias and heart failure. With an infarction of the interventricular septum, a septal aneurysm can form, a protrusion of the interventricular septum into the cavity of the right ventricle, which leads to right ventricular failure, liver enlargement, edema, ascites.

If parietal blood clots develop in the cavities of the heart, their fragments can break off and cause embolism in the arteries that supply blood to the internal organs of the brain, kidneys, spleen, etc. and limbs.

Among the late complications of myocardial infarction, thromboembolism of the pulmonary arteries is often observed in connection with phlebothrombosis of the veins of the lower extremities and pelvic organs, the development of which is predisposed by the elderly age of patients and excessively long immobile stay in bed. Late complications of myocardial infarction also include various cardiac arrhythmias, heart failure, and autoimmune post-infarction syndrome.

1.6 Treatment of myocardial infarction

The primary and most important measure in acute myocardial infarction is relief of a painful attack. For this purpose, the average health worker can administer intramuscularly 2 ml of a 50% analgin solution in combination with 1 ml of a 1% diphenhydramine solution. As prescribed by the doctor, narcotic analgesics are administered in his presence - promedol (1-2 ml of 2% solution), morphine (1-2 ml of 1% solution), omnopon (1-2 ml of 1% solution) in combination with 0.5 ml 0.1% atropine solution subcutaneously, intramuscularly or intravenously, fentanyl (1-2 ml of 0.005% solution) in combination with the neuroleptic droperidol (1-2 ml of 0.25% solution), diluted in 20 ml of 5% glucose solution or the same amount of isotonic sodium chloride solution is administered slowly intravenously. In case of severe suffocation, the patient should be placed in a semi-sitting position with legs down, with low blood pressure, only slightly raise the head end of the bed, and allow oxygen to be inhaled through gauze moistened with 70% ethyl alcohol.

Regardless of whether the pain was relieved completely or partially, emergency hospitalization is indicated for all patients with myocardial infarction. The patient is transferred to a vehicle on a stretcher. In small houses with narrow staircases, you can carry the patient up the stairs on a strong chair, slightly tilted back. The patient is transported to the hospital in a supine position; if there are signs of left ventricular failure, suffocation, bubbling breathing, the head end of the stretcher should be raised and the patient should be allowed to inhale vapors of alcohol and oxygen.

If possible, patients with acute myocardial infarction are hospitalized in special wards in intensive care units equipped with equipment that allows them to constantly monitor ECG and other circulatory indicators and, if necessary, provide emergency assistance to the patient - artificial ventilation, cardiac defibrillation, and electrical cardiac stimulation.

Sometimes, in order to stop the spread of myocardial necrosis, drip intravenous administration of nitroglycerin is prescribed to reduce the load on the heart, taking anaprilin and other drugs that reduce the myocardial oxygen demand.

Surgical treatment of myocardial infarction is indicated if, after dissolution of the thrombus, X-ray angiograms reveal stenosis of a large branch of the coronary artery. An operation is used to widen the narrowed section of the artery using a special catheter, at the end of which there is a balloon that can straighten, but not stretch, when fluid is pumped into it under pressure. In the acute period of myocardial infarction, aortocoronary or mammary-coronary bypass surgery is sometimes performed to create bypass paths between the aorta or internal mammary artery and the coronary artery below the narrowing site using prosthetics. There are individual reports of successful surgical treatment of acute cardiac aneurysm, excision, rupture of the papillary muscle, replacement of the mitral valve and interventricular septum (septal plastic surgery, as well as cardiac rupture, excision of the necrotic area of the myocardium.

Of particular importance in preserving the life of the patient is timely and sufficiently vigorous treatment of complications of myocardial infarction. In case of cardiogenic shock, the patient is placed in a horizontal position. In the absence of a doctor, the average health care worker can, according to vital indications, slowly inject into a vein 0.5 ml of a 1% solution of mezatone in isotonic sodium chloride solution, and it must be observed that the systolic pressure does not exceed BUT mmHg. Art. As prescribed by the doctor, mesaton, norepinephrine or dopamine (dopamine) is administered intravenously, focusing on the same systolic pressure indicator. If drug therapy is ineffective, assisted circulation is used, especially balloon counterpulsation.

During development severe violations heart rhythm of ventricular extrasystole of high degrees or ventricular tachycardia, 5-6 ml of a 2% lidocaine solution is injected intravenously, after which its drip infusion is established at a speed of 2-4 mg / min if 200 mg of solvent contains 10 ml of a 2% lidocaine solution, average speed introduction approx. 60 drops per 1 min. If medications are ineffective in the case of ventricular tachycardia, it is indicated electropulse therapy. In cases of progressive atrioventricular block, temporary endocardial electrical stimulation of the heart is established.

In case of cardiac asthma or pulmonary edema, raise the head end of the bed. As prescribed and in the presence of a doctor, lasix 40-160 mg, corglicon or strophanthin, narcotic analgesics morphine, promedol, omnopon or fentanyl with droperidol are administered intravenously. With the help of special suctions, foamy sputum is evacuated from large bronchi. To destroy foam in the small bronchi, inhalation of oxygen with ethyl alcohol vapor is used (50% when breathing through a mask and 70% when using a nasal catheter). Sometimes they resort to artificial ventilation of the lungs under high pressure, as well as blood ultrafiltration - removing part of the water contained in the blood with electrolytes dissolved in it using special devices.

The regimen of a patient with myocardial infarction depends on the size of the damage to the heart muscle and the time that has passed since the onset of the disease. For small-focal myocardial infarction, mild bed rest is prescribed for 1-2 days. If the doctor is convinced that there is no tendency for expansion or recurrence of myocardial infarction, the patient is transferred to the ward mode, and after a week he is allowed to move within the department with gradual further activation. The timing of activation in patients with extensive intramural as well as transmural myocardial infarction is determined by the doctor. Usually, with an uncomplicated transmural infarction, the patient begins to sit up in bed with the help of a nurse or exercise therapy methodologist on the 8th–12th day of the disease, and is allowed to walk around the ward on the 14th–20th day; discharged from the hospital approximately 30-35 days after the onset of the disease.

The patient's diet in the first days of the disease includes easily digestible foods: juices, jelly, soufflé, soft-boiled eggs, and kefir. Products that cause increased gas formation in the intestines are excluded. If the patient has a complete lack of appetite, he should not be forced to eat. From the 4th day of the disease, the diet is gradually expanded and by the 7th day they switch to diet No. 10.

Therapeutic exercise is one of the most important methods in the rehabilitation system of patients with myocardial infarction. It helps stimulate the auxiliary mechanisms of blood circulation, facilitating the work of the heart, training the contractile function of the weakened heart muscle and the apparatus for regulating systemic hemodynamics. Under the influence of exercise therapy, breathing is moderately activated, the tone of the nervous system increases, and gastrointestinal function improves. -kish. tract, which is especially important during the period the patient is on bed rest.

In case of myocardial infarction of moderate severity, exercise therapy begins on the 2-3rd day, and in case of more severe ones - on the 3-7th and later days of the disease. In the initial position lying on your back, apply simple exercises in the distal parts of the limbs, which are performed smoothly, rhythmically, without jerking. Each exercise should be alternated with breathing. Free, rhythmic, non-fatiguing movements in the large joints of the limbs are necessary, ch. arr. lower, alternating with breathing exercises and rest breaks. To prevent atrophy of skeletal muscles and weakness of the ligamentous apparatus, treatment is also used. massage. With the doctor's permission, usually by the end of the 2nd week the patient is taught to sit up in bed without straining, and in the following days to sit on the edge, eat and use the toilet in a sitting position. First, he is helped by a methodologist and support staff, and then he acts independently, but without pronounced effort and holding his breath. When the patient adapts to being in an upright position, he is allowed to transfer to a chair or armchair, walk around the bed with the help of a methodologist and under the supervision of a doctor. Preparation for walking is first carried out in a sitting position (seated walking), then standing with support on the back of a chair, walking in place, after which walking around the ward is allowed. From the moment when the doctor allows the patient to walk indoors, they begin with walking at a distance of no more than 20-50 m, gradually increasing the number of such walks per day. The first ascents of 1 flight of stairs and walks outside the premises are carried out under the guidance and accompaniment of a physical therapy methodologist. Initially the patient passes approx. 100 m, subsequently the duration of walks gradually increases so that by the end of the hospital stay the patient is capable of self-care, walking a distance of 500-1000 m, climbing stairs to the 1st floor without significant discomfort. In each specific case, the question of the activity mode is decided individually, taking into account not only the wedge, the data, but also the psychological mood of the patient. After discharge from the hospital, the patient is recommended to use it for the first 2 weeks. continue physical therapy classes using the same set of exercises that he performed in the hospital. In the future, walks on fresh air with a gradual increase in their duration from 20-30 minutes to 1 hour 2-3 times a day. After the patient begins to visit the clinic, the attending physician refers him to the exercise therapy room of the clinic or medical and physical education dispensary, where exercise therapy classes continue and further consultations are given on the organization of the motor regimen. Caring for a patient with acute myocardial infarction, especially in the first days of the disease, when the patient is on strict bed rest, should ensure the exclusion of unacceptable physical and emotional stress for the patient. During this period, as a rule, the nurse must feed the patient, although if the patient insists, with the doctor’s permission, he can eat on his own, especially if the bed is equipped with a bed table. In the first days of illness, the nurse washes the patient daily; later, when the patient is allowed to sit, she helps him wash. If the patient's stay on bed rest is prolonged due to complications, it is necessary to turn the patient in bed every day, wipe his skin with camphor alcohol, eau de toilette or cologne. In the first 2-3 days of the disease, the patient is not allowed to shave on his own.

Of particular importance is the regulation of physiol, departures. As a rule, patients develop constipation in the first days of myocardial infarction, to eliminate which unsalted laxatives buckthorn, alexandria leaf, vaseline or vegetable oil are used. It is often necessary to cleanse the intestines with an enema. In the absence of stool for a long time, it may be necessary to manually destroy the fecal plug in the rectum. Sometimes the doctor allows patients who cannot empty their bowels while lying in bed to transfer to a bedside chair for this purpose already from the 2nd-3rd day of illness in cases where the patient’s efforts spent on bowel movements in bed significantly exceed the efforts required for the transplant onto the toilet seat with the help of a nurse. It is necessary that the patient has stool at least once every 2 days.

If a patient retains urine, the doctor determines the cause. If necessary, the bladder is emptied through a urinary catheter; in some cases, the catheter is left in urinary tract for 1-2 days, after which the patient is allowed to empty the bladder independently. If the patient empties his bladder while standing, then the nurse should help him get out of bed with minimal stress: first he needs to be turned on his right side, asked to bend his legs; then they lower the legs of the lying patient, after which they help him sit up in bed, and after 2-3 minutes of rest, help him get up. The patient must be supported while urinating.

Rehabilitation therapy for patients with myocardial infarction begins in a hospital setting. It is aimed at restoring, if possible, the patient’s full general physical and mental state. Allowing the patient to eat and shave independently is one of the rehabilitation measures: most patients, having received such permission, believe that they have already begun to recover. Rehabilitation measures include timely expansion of the regimen and the appointment of exercise therapy. A confidential conversation with the patient about other patients who were in the hospital with the same disease, and are now leading full-time work and normal life, is psychologically useful. family life. In the USSR, in many regions and autonomous republics, special rehabilitation departments for patients with myocardial infarction have been created in cardiological sanatoriums, where physical therapy methodologists and a psychologist participate in the implementation of rehabilitation measures along with the attending physician.

1.7 Prognosis of myocardial infarction

Z depends on the extent of myocardial infarction, as well as on the presence and nature of complications in the acute and subsequent periods. With uncomplicated and not very extensive or small-focal myocardial infarction, the prognosis for life and recovery is usually favorable. It is significantly worse in cases of extensive myocardial infarction, especially with acute aneurysm of the left ventricle, as well as in complications of myocardial infarction with severe disturbances of heart rhythm and conduction, heart failure. If, after a myocardial infarction, even not a very extensive one, the patient still has angina pectoris or has developed for the first time, as well as if ventricular heart rhythm disturbances have appeared, the prognosis for life in the coming months and years remains doubtful, since in these pathological conditions it increases significantly risk of recurrent myocardial infarction or sudden death from ventricular fibrillation. Almost complete recovery is sometimes observed only in small-focal, less often intramural, and very rarely in transmural myocardial infarction with a small area of damage, which proceeded without complications. In other cases, recovery for one reason or another is regarded as partial, since the presence of a post-infarction scar predisposes to cardiac arrhythmias and the gradual development of heart failure, especially if the myocardial infarction is complicated by a cardiac aneurysm. Restorative rehabilitation measures allow you to return to work after 4 months. from the moment of myocardial infarction, most patients. Restoration of working capacity can be complete or partial, depending on whether there are manifestations of heart failure or the danger of its development (cardiac aneurysm), on the severity of angina pectoris, the presence and nature of heart rhythm disturbances, as well as on the extent to which angina pectoris and cardiac disturbances rhythm is inferior to the action to lay down. events.

1.8 Prevention Prevention of myocardial infarction is annual medical examination and timely adequate treatment of chronic diseases such as coronary heart disease, hypertension, atherosclerosis.

The diagnosis of coronary heart disease is the basis for assessing the condition of the coronary arteries using coronary angiography. Specially made x-rays allow you to determine the exact location of atherosclerotic plaques and the degree of narrowing of the coronary arteries. If indicated, the found narrowings can be expanded from inside the vessel - this procedure is called coronary angioplasty. In addition, a wall can be implanted into the coronary artery - a metal frame that will maintain the open state of the vessel. In some cases, they carry out complex operation coronary artery bypass surgery, when additional vessels are inserted between the aorta and the coronary arteries, going around the narrowing of the coronary vessel and creating the opportunity for blood to flow to the heart muscle

CHAPTER 2. MODERN APPROACHES TO THE TREATMENT OF ACUTE MYOCARDIAL INFARCTION

2.1 Thrombolytics used in thrombolytic therapy Thrombolytics used in thrombolytic therapy Streptokinase - 1.5 million units. in 30−60 minutes. per 100 ml of saline solution or 5% glucose. Alteplase, a fibrin-specific agent, can be prescribed after 4 hours, and can be re-prescribed in case of restenosis. New recombinant (product genetic engineering) tissue plasminogen activators allow intravenous bolus administration - lanateplase, reteplase, tenecteplase. Tenecteplase is recommended for polar administration at the prehospital stage. However, even with a typical anginal attack not accompanied by ECG dynamics, or if these changes concern the T wave (including inversion) or ST segment depression, TLT is not indicated. The effectiveness of thrombolytic therapy is also influenced by the time of day - recanalization occurs worse in the morning, i.e., when the reactivity of platelets and coagulation processes, as well as blood viscosity, vasomotor tone and natural inhibition of fibrinolysis have their maximum daily values. A rapid decrease of more than 80% in previously elevated ST segment levels detected by standard ECG allows one to accurately identify patients with a good prognosis for MI. These patients do not require additional treatment measures in the future. In contrast, the absence of a significant reduction in ST segment elevation by no more than 20% indicates with a high level of confidence that coronary recanalization has not been successful. Complications of thrombolytic therapy: * acute disorders rhythm (ventricular fibrillation - considered as an indicator of recanalization) - readiness for defibrillation; * restenosis of the coronary artery, while the course of myocardial infarction becomes more severe. Unconditional contraindications to thrombolytic therapy (European Society of Cardiology): - history of stroke; - recent (within the previous 3 weeks) serious injuries, major surgery or head injury; - massive gastrointestinal bleeding (not exacerbation peptic ulcer without bleeding) during the previous month; - known disorders in the blood coagulation system; - increased bleeding; - aortic dissection. Relative contraindications to thrombolytic therapy include: - previous disorders cerebral circulation within the previous 6 months; - treatment indirect anticoagulants; - pregnancy; - puncture of non-compressible vessels (for example, the subclavian vein, when there is a high probability of using TLT, heparin, it is not recommended to use this access to install infusion cannulas); - traumatic resuscitation; - refractory arterial hypertension - systolic blood pressure more than 180 mm Hg; - recent retinal laser therapy. Aspirin inhibits the action of cyclooxygenase in platelets, thereby preventing the synthesis of thromboxane A2, which has a powerful vasoconstrictor and aggregation effect. It can be used alone or in combination with heparin. Aspirin dose 375−500 mg - chew. Thrombosis should not be prescribed in the first hours of myocardial infarction due to its slow absorption. The antiplatelet effect of ticlopidine manifests itself after 8-12 hours and, with continued use of the drug, reaches its maximum severity by 3-5 days, so it cannot be used for emergency therapy. The use of anticoagulants is described in sufficient detail in the article on acute coronary syndrome.

2.2 General rules for caring for patients with pathology of the cardiovascular system The psychological aspects of the problem are explained, first of all, by the fact that any patient is in a certain dependence on medical workers. therefore, the ability to instill self-confidence, warmth and sincerity of conversations with the patient form an integral part of the work. when working in an outpatient setting, this contact is less important, since the patient spends most of his time at home, in his usual, familiar environment. this fact usually has a calming effect, and most patients do not rush to the hospital unless absolutely necessary. However, when the patient arrives at the clinic, his first meeting is with a paramedic, when he issues a number to the doctor, measures his blood pressure and tells the patient that it is very high, it is unlikely that further consolation will have the desired effect. It must be remembered that most patients, especially those with pathology of the cardiovascular system, are suspicious. They cannot immediately be told about all the changes detected in them. but at the same time, whispering behind their back makes a bad impression on patients, which is often perceived by them as a desire to hide something dangerous for them. therefore, one must always behave calmly, calmly, and confidently with patients. The doctor must provide information about the patient’s condition and any indicators identified in him.

A number of patients with pain in the heart area are sent for examination, most often to take an electrocardiogram. sometimes after this there is a need for urgent hospitalization due to deterioration of coronary circulation and the increase (appearance) of various types of arrhythmias. You need to inform the patient about this tactfully and quite carefully. Otherwise, the patient's condition may deteriorate sharply, and even where there was none, myocardial infarction may develop. When the patient is hospitalized, the average medical worker is the first person the patient meets. It should be remembered that the first impression plays a very important role in further contact with the patient. therefore, the patient must be greeted warmly and kindly. In the communication between a sister and a patient, there are three periods: the first is acquaintance, the second is the period of fairly long communication, and the third is the period of separation. During this entire time, the sister must be sufficiently attentive and helpful.

First of all, you need to establish contact with the patient. he must know and feel that his sister will always come to him and help. Some neurotic patients are afraid to fall asleep at night, believing that they might die in their sleep. in this case, the sister should approach the patient several times a night and convince him that she is always there. Some patients are afraid of developing an attack of chest pain during sleep. in this case, before going to bed, you need to give an appropriate vasodilator, which will prevent the development of an attack and thus break the resulting “vicious circle”. but all this can only be found out if there is contact with the patient. This is facilitated, first of all, by the ability to listen. contact and trust are the cornerstones of communication between a nurse and a patient. however, one must remember the need to maintain confidentiality and what the patient said cannot be discussed with other persons except the attending physician.

Some patients who have suffered a severe attack of pain (myocardial infarction) are afraid of being discharged. Therefore, they can make a lot of complaints, it happened before. this is their defensive reaction upon discharge from the hospital, where, as they are convinced, they always receive emergency care. This primarily applies to lonely patients. Therefore, it is necessary to conduct preparatory conversations with these persons in advance, reassure them, and talk about the basic means of first aid. At the same time, you must not irritate or tell anyone that you are glad that this person has been discharged. firstly, this can be passed on to the patient even after discharge, and secondly, it will ruin your relationship with patients, since they will be afraid that after their discharge you will say the same thing. The technical side of patient care lies, first of all, in strict compliance with all instructions doctor There may be a need for an urgent injection (subcutaneous or intramuscular), or intravenous infusion of medications. The ability to perform all these manipulations is a necessity for the work of any nurse, especially those serving patients with pathologies of the cardiovascular system. (myocardial infarction, cardiac asthma) require strict bed rest. therefore, the nurse must be able to remake the bed, change the patient’s clothes, and clean the skin. it is necessary to remember that the appearance of infiltrates, abscesses and bedsores is a work defect, and each such case must be carefully analyzed together with the older sister and the head of the department. Each pathology has its own characteristics of the course and, therefore, care

2.3 Caring for seriously ill patients with myocardial infarction A seriously ill patient receives nursing care and attention, since in most cases he is helpless and cannot take care of himself.

He needs constant help

1. oral care

2. eye care

3. nose care

4. washing

5. wet wipe

6. care to prevent bedsores from forming

7. change of bed linen and underwear; oral care; furacillin solution (2 tablets per 400 ml of water); soda solution (½−1 teaspoon per glass of water); solution boric acid(1−2% solution); slightly pink solution of potassium permanganate (1:5000);

chamomile decoction; decoction of oak bark (for bleeding gums

To treat the cavity you need to prepare:

· toothbrush and paste or gauze swabs, a napkin, a clamp and a container with an antiseptic solution;

· pear-shaped balloon - for those who cannot hold water in their mouth, or a glass;

· a container for spitting (a kidney-shaped tray, a regular bowl or a small basin);

· a spatula (if you don’t have one, you can use the handle of a spoon) - to move the cheek away and press the tongue;

· gloves, preferably latex;

Vaseline or hygienic lipstick.

To treat the oral cavity you should:

· give the patient a comfortable position sitting or lying down (lying down - the head must be turned to the side);

· put on gloves;

· Clean your teeth with a gauze swab moistened with an antiseptic solution or a toothbrush;

· continue processing, moving from the molars to the incisors and changing tampons (on average, 10-15 tampons are needed to treat the mouth);

· movements of the toothbrush are carried out along the axis of the tooth (up and down), capturing part of the gum. It is not recommended to brush your teeth using movements across the axis of the teeth, as this can lead to abrasion of the enamel in the area of the tooth neck;

· Clean your tongue last. If you don't hold your tongue, it will be difficult to clean, so wrap it in gauze and pull it towards you. When removing plaque, do not press on the root of the tongue so as not to accidentally induce vomiting;

· ask the patient to rinse his mouth well or rinse with an antiseptic solution from a pear-shaped balloon;

· dry lips and skin around the mouth;

· lubricate lips with Vaseline or hygienic lipstick;

· remove the equipment;

· remove gloves, wash hands

eye care

Target. Prevention of purulent eye diseases.

Indications. Purulent discharge from the eyes, sticky eyelashes in the morning.

Equipment. Sterile kidney-shaped basin with 8 - 10 sterile cotton balls; kidney-shaped basin for used balls; two sterile gauze pads; pale pink potassium permanganate solution or furatsilin solution 1:5000.

Execution technique.

1. The nurse washes her hands with soap.

2. Pour a small amount of disinfectant solution into a bowl with balls.

4. A cotton ball soaked in a disinfectant solution is taken with 1 and 2 fingers of the right hand and squeezed lightly

5. Ask the patient to close his eyes. Rub one eye with a ball

in the direction from the outer corner of the eye to the inner.

6. If necessary, repeat the procedure.

7. Blot the remaining antiseptic with a sterile napkin from the outer corner of the eye to the inner one.

8. Repeat the manipulation with the second eye.

Note. To avoid transfer of infection from one eye to another, different balls and wipes are used for each eye.

Caring for the nose of a seriously ill patient.

Target . Cleansing the nasal passages from crusts.

Indications. Accumulation of crusts in the nasal cavity in patients in a passive position.

Equipment. Cotton turundas; Vaseline or other liquid oil: sunflower, olive, or glycerin; two kidney-shaped basins: for clean and used turundas.

Execution technique.

1. The patient’s head is elevated and a towel is placed on the chest.

2. Moisten the turundas with the prepared oil.

3. Ask the patient to tilt his head back slightly.

4. Take the moistened turunda, squeeze it lightly and insert it with a rotational movement into one of the nasal passages.

5. Leave the turunda for 1 - 2 minutes, then remove it with rotational movements, freeing the nasal passage from crusts.

6. Repeat the procedure with the second nasal passage.

7. Wipe the skin of the nose with a towel and help the patient lie down comfortably.

Caring for the hair of a seriously ill patient.

Target . Maintaining the patient’s personal hygiene; prevention of head lice and dandruff.

Equipment. A basin of warm water; jug with warm water (+35…+37 C); towel; comb; shampoo; scarf or scarf.

Execution technique.

1. Ask the nurse to lift the patient’s torso, supporting him by the shoulders and head.

2. Remove the pillows, roll the head end of the mattress with a bolster towards the patient’s back, and cover it with oilcloth.

3. Place a basin of water on the bed frame.

4. Wet the patient’s hair, wash it with shampoo, and rinse thoroughly in a basin.

5. Rinse your hair with warm water from a jug.

6. Dry your hair with a towel.

7. The basin is removed, the mattress is laid out, pillows are placed, and the patient’s head is lowered.

8. Comb the hair with a comb belonging to the patient. Short hair comb from the roots of the hair, and long hair from the ends, gradually moving towards the roots.

9. They tie a scarf or scarf around their head.

10. Help the patient lie down comfortably.

Notes If the patient does not have his own comb, you can use a common one, which is pre-treated with 70% alcohol, wiping 2 times with an interval of 15 minutes. Patients need to comb their hair daily. While washing the hair, the nurse must support the patient at all times.

Prevention of bedsores, implementation algorithm

Manipulation: prevention of bedsores .

Target. Prevention of necrosis of soft tissues in places of prolonged compression.

Indications. Bed rest for the patient.

Equipment. Anti-bedsore mattress; cotton-gauze backing circles; rubber circle in a pillowcase; petrolatum; 1% solution of table vinegar; portable quartz lamp; clean soft terry towel.

Technique for preventing bedsores.

1. Wash and dry your hands, put on gloves.

2. The patient is turned on his side.

3. Treat the skin of the back with a napkin moistened with warm water or a vinegar solution.

4. Dry the skin with a dry towel.

5. Massage the areas where bedsores often form.

6. Lubricate the skin with sterile Vaseline or boiled vegetable oil.

7. The resulting bedsores are treated with quartz treatment, starting from 1 - 2 minutes and gradually increasing the exposure time to 5 - 7 minutes.

8. Place cotton-gauze circles or rubber circles in a pillowcase under the places where bedsores form.

9. Inspect the patient’s bed, remove crumbs after eating.

10. Wet and soiled bed linen and underwear are changed immediately.

12. When changing bed and underwear, make sure that there are no seams, patches, or folds on them in places where bedsores form.

13. Areas of skin redness are treated with a weak solution of potassium permanganate. Skin treatment for seriously ill patients .

Target . Maintaining personal hygiene of a seriously ill patient; prevention of bedsores.

Indications. Patient's bed rest. Patients on semi-bed rest take care of themselves.

Equipment. A basin marked “For washing”; a jug or kettle with warm water (+35...+38 °C) marked “For washing”, a basin with hot water(+45…+50 °С); napkin or piece of cotton wool; towel; powder, sterile oil; 10% camphor alcohol or 1% vinegar solution.

Technique for performing skin treatment for seriously ill patients:

1. Place the basin on a stool at the edge of the patient’s bed.

2. If the patient can turn on his side, then ask him to do this and help the patient wash his hands over the basin, brush his teeth, and wash himself. Nurse holding a jug, serving toothpaste, glass of water, towel.

3. If the patient cannot turn on his side. then perform the following manipulations: Wash one of the patient’s hands in a basin with soap and water. Transfer the basin to the other side of the bed and wash the other hand. Fingernails are cut oval.

Perform facial toileting: wipe it with a damp cloth, then with a dry towel. The pillows are removed and the patient's shirt is removed. Wet the napkin in a bowl of hot water and wring it out. They wipe the front surface of the patient's body, paying attention to the natural folds of the skin on the neck, under the mammary glands, in the armpits, and in the groin folds. Dry the skin thoroughly with a towel. Skin folds are treated with powder or lubricated with sterile oil to prevent diaper rash.

The patient is turned on his side. If necessary, the orderly helps and supports the patient. Wipe the skin of the back with a damp, hot cloth, paying special attention to the places where bedsores form (the back of the head, shoulder blades, sacrum, buttocks). The skin is thoroughly dried with a towel and rubbed, if there are no violations of its integrity or pain. The warmth of the wipe and rubbing will cause a rush of blood to the skin and underlying tissues.

If the patient cannot be turned on his side, he is placed on a sectional mattress. Skin care is carried out by removing one section after another.

Notes Patients' skin should be washed daily. Also, the patient’s feet should be washed every night at night, placing a basin of water on the bed frame. The mattress is first wrapped with a cushion towards the feet and covered with oilcloth. Toenails are cut straight.

If the patient is immobile for a long time, it is necessary to take preventive measures to prevent the formation of bedsores.

Washing up patients.

Target . Maintaining hygiene; prevention of bedsores, diaper rash.

Indications. Preparing the patient for urine collection for examination, bladder catheterization; gynecological manipulations. All patients on bed rest are washed in the morning, at night and after each bladder and bowel movement.

Equipment. Oilcloth lining; metal or plastic vessel; Esmarch's jug or mug marked “For washing”; warm water(+35…+38 °С); 5% potassium permanganate solution; forceps; cotton wool; kidney-shaped coxa; rubber gloves.

Technique for washing patients:

1. Pour water into a jug (Esmarch mug) and add a few drops of 5% potassium permanganate solution until a pale pink color is obtained.

2. Put on gloves.

3. Ask the patient to lie on her back, bend her knees and spread them at the hips.

5. A piece of cotton wool is fixed in a forceps so that its sharp edges are covered on all sides.

6. Take a jug with a warm disinfectant solution in your left hand and, after pouring a small amount of the solution onto the patient’s thigh, ask: “Are you not feeling hot?” If the water temperature is acceptable, continue manipulation.

7. Irrigate the genitals with a warm disinfectant solution. With your right hand, take a forceps with cotton and wash the genitals in the direction of the stream towards the anus, so as not to cause an infection. First, the labia minora are washed, then the labia majora, inguinal folds, and pubis. Lastly, wash the anus from top to bottom.

8. Remove the dirty cotton swab from the forceps, attach a clean piece of cotton wool and dry the genitals in the same sequence.

9. They remove the bedspread and help the patient take a comfortable position in bed.

Men are washed for the same indications. When washing, the important rule is “from the center to the periphery,” that is, from the head of the penis to the groin area.

Notes Patients on semi-bed rest should be taught to use a bidet, if one is available on the ward.

Changing bed linen for a seriously ill patient, implementation algorithm

Changing bed linen for a seriously ill patient. Target. Creating bed comfort (one of the measures of the medical and protective regime); prevention of bedsores; maintaining the patient's personal hygiene.

Indications. Patient's bed rest.

Equipment. A clean sheet, large enough in size, without seams or patches; clean duvet cover; two pillowcases.

Technique:

Longitudinal method of changing bed linen for a seriously ill patient:

- used when the patient can be turned on his side.

Longitudinal method of changing bed linen for a seriously ill patient

1. Roll up a clean sheet with a roller along 2/3 of its length.

2. Remove the blanket, carefully lift the patient’s head and remove the pillows.

3. Turn the patient on his side away from you.

4. On the vacant half of the bed, roll the dirty sheet with a roller towards the middle of the bed (under the patient).

5. A prepared clean sheet is rolled out onto the vacant part of the bed with the roller facing the patient.

6. Turn the patient onto the other side to face you.

7. Remove the dirty sheet from the vacated part of the bed, straighten the clean one, stretch it and tuck it under the mattress on all sides.

8. Place the patient on his back, place pillows in clean pillowcases.

9. Change the duvet cover and cover the patient with a blanket.

Transverse method of changing bed linen for a seriously ill patient:

- used when the patient cannot be turned on his side, but the upper body can be seated or raised.

Transverse method of changing bed linen for a seriously ill patient

1. The sheet is rolled up 2/3 of the width.

2. Ask the nurse to lift the patient, supporting him by the back and shoulders.

3. Remove the pillows and roll the dirty sheet to the patient’s back.

4. A clean sheet is rolled out towards the patient’s back.

5. Place pillows in clean pillowcases and lower the patient onto the pillows.

6. Ask the nurse to lift the patient in the pelvic area.

7. Roll up the dirty sheet from the vacated part of the bed and roll out a clean one, laying the patient down.

8. Ask the nurse to lift the patient’s legs.

9. Remove the dirty sheet from the bed and roll out the clean sheet until it’s finished.

10. A clean sheet is tucked under the mattress on all sides.

11. Change the duvet cover and cover the patient.

Changing underwear (shirt) for a seriously ill patient.

Target . Maintaining the patient’s personal hygiene; creating bed comfort; prevention of bedsores and diaper rash.

Indications. Patient's bed rest.

Equipment. A clean shirt is larger than the patient's clothing size.

Execution technique.

1. Slightly raise the patient's head and remove the pillows.

2. Carefully lifting the patient, collect the shirt up to the armpits, and along the back to the neck.

3. Fold the patient's arms over his chest.

4. With your right hand, support the patient’s head by the back of the head, and with your left hand, grabbing the shirt gathered on the back, carefully remove it, without touching the patient’s face with the dirty shirt.

5. Lower the patient's head onto the pillow.

6. Release the arms from the sleeves: first the healthy one, then the sick one.

7. You can put a clean shirt on a seriously ill person by performing all the steps exactly in the reverse order, i.e., gathering the clean shirt along the back, putting the sleeve on the sore arm, then on the healthy one; fold your arms across your chest and support right hand the patient's head, with your left hand put the shirt through the neck hole onto the patient's head, straighten the shirt to the bottom.

Notes Clean linen is kept by the sister-owner of the department. Dirty linen is collected in the ward in oilcloth bags marked “For dirty linen” and sent to a special room. When changing linen, neither clean nor dirty linen should be placed on patients' bedside tables or adjacent beds.

Linen is changed regularly, at least once every 5 days, after a hygienic bath, and, if necessary, more often, as it gets dirty. The underwear of untidy patients, as well as underwear contaminated with blood and pus, should be changed only with rubber gloves and a mask.

CHAPTER 3. PRACTICAL PART

3.1 Characteristics of health care facilities When writing the practical part, statistical materials from the emergency treatment department of the Komi Republican Cardiology Dispensary were used.

The Republican Cardiology Dispensary was opened on August 18, 1997, designed to provide medical, advisory, organizational and methodological assistance. as the largest and leading specialized medical institution republics. it forms a policy for the prevention, timely detection and treatment of cardiovascular pathology.

Currently, the Cardiological Center has been renamed into the Cardiological Dispensary of the Komi Republic KDRK.

The main issue being resolved by the institution is the creation of conditions for the implementation of a regional cardiology program, the purpose of which is to provide affordable cardiac care to the population. this includes the definition of a high-risk strategy to identify people with a high likelihood of developing coronary heart disease (CHD) and acute myocardial infarction (AMI), predicting the risk of sudden cardiac death, timely hospitalization, thorough examination and care necessary assistance. The cardiological dispensary conducts personnel training, advisory, scientific, practical, organizational and methodological, therapeutic and surgical activities.

Unique devices and complexes allow diagnosing and treating patients at the level of the most modern medical technologies. The CDC includes a hospital with a capacity of 450 beds, a consultative clinic with a capacity of 200 visits per shift, a specialized maternity hospital, antenatal clinic, diagnostic complex, pharmacy, operating room, intensive care unit, physiotherapy building, pediatric cardiology department, cardiology department 4 (with blood clots), rhythm disturbance department. rheumatism department, as well as the administrative building.

The cardiology clinic starts working from 8 a.m. to 6 p.m. in clinics and planned hospitalizations. When seen by a doctor, the patient goes to the reception desk and gives a passport, personal identification number, medical card, a referral from who sent it and from where. There is also a cardiology clinic in the Komi Republic with an emergency room that operates around the clock.

The cardiology clinic employs about 1,100 employees, of which 200 are doctors and 400 paramedical workers; 1 candidate of medical sciences, 2 cardiologists of the first category, 1 cardiologist of the second category work in the emergency cardiology department No. 1. 1 anesthesiologist-resuscitator of the highest category and 1 anesthesiologist-resuscitator of the first category with work experience of up to 10 years - 3 doctors, over 10 years - 2 doctors, over 20 years - 1 doctor.

Among nurses I have qualification categories of 15 people, including the highest - 5, first - 10, second - 2

Emergency Department No. 1 (NK-1) with 60 beds began operating on December 8, 1997. The department is designed to treat patients with acute coronary syndrome (ACS), primarily unstable angina (AS) and acute myocardial infarction (AMI). On September 14, 1999, the intensive care ward of PIT NK-1 with 6 beds was opened in PIT NK-1. The following groups of patients are hospitalized

— with uncomplicated AMI

- with suspicion of AMI without impaired hemodynamics with UA without hemodynamic impairment with AMI and UA from the ICU for further treatment and observations.

From department NK-1 with deterioration general condition and the need for dynamic monitoring. The ICU is equipped with the necessary equipment to monitor the condition of patients and provide qualified emergency care at the right time. Since September 15, 2001, the department has opened 24 emergency gerontology beds. The department has four round-the-clock posts, one of them is an intensive care post. The two wings of the department contain seven rooms for three people, one room for two, a single room, as well as staff rooms, a bathroom, an enema room, a sanitary room, a buffet, and a ventilation chamber. between the right and left there are four coronary chambers - two for two and two for singles and an intensive care post with 6 beds. For each patient in the ward there is a centralized supply of oxygen, vacuum, compressed air, an emergency nurse call and lighting. The department has the following offices: the head, the head nurse, the hostess sister and three resident rooms. There is also a room for collecting clinical blood tests, a treatment room for intramuscular injections, and a room for dispensing tablet medications. The department has two lounges for patients with advanced motor movements to relax and watch TV.

Timekeeping of a nurse's working hours

1.produced on time

main activity

IM injection -195 min

· distribution of medicines -54 min

· measurement of blood pressure, pulse - 18 min

temperature measurement - 15 min

· feeding patients 75 min

· assistance in carrying out hygiene procedures-20 min

· hygienic measures in bed (toilet skin, eyes, nose, treatment of bedsores, etc.) - 30 min

· preparing the patient for the study -25 min

catheter placement -15 min

· enema administration -24 min

· participation in performing a spinal puncture -32 min

· care of the nosogastric tube, feeding through the tube 40 min

· collection of urine for examination, measurement of diuresis - 20 min

· application of lotions, compresses – 25 min

· instillation of drops into the nose and eyes - 10 min.

· taking a swab from the throat -2 min auxiliary activity

· preparation for work, reception and handover of shifts, preparation and cleaning of the workplace - 30 min

· interaction with employees of other services in the interests of the patient (recording an ECG, ultrasound, FGDS, consultations with specialists) - 22 min

· receiving and arranging medications – 7 min

Accompanying the patient for examination -27 min

· washing of instruments, preparation for delivery to the central dispensary, preparation of materials and containers for autoclaving -27 min

· preparing disinfectants, washing hands -13 min

· washing of preparation instruments for delivery to the central dispensary, preparation of materials and containers for autoclaving -27 min

· preparation of disinfectant solutions, washing hands - 13 min.

· calling a patient to the office to conduct a study - 18 min work with documentation

· checking appointment sheets, working with medical histories -150 min

· filling out logs (transfer of shifts, transfer of tools, log of transfers of narcotic substances, accounting of alcohol) -30 min

· preparation of a medical history as prescribed by doctors for diagnostic studies, their transportation and timely return to the department -60 min

· filling out an application for medications -10 min

· preparation of portion requirements and movement sheets -20 min

· gluing the results laboratory research 20 min office conversations

· handover and reception of shifts -30 min

· participation in morning conferences -15 min

· discussion of the patient’s problems with the doctor - 20 min

· discussion of the patient’s problems with relatives -7 min

answering phone calls -17 min

Conducting conversations with patients -15 min economic activity

· provision of medicines, sterile instruments, dressings - 15 min

· chores-23 min other

· transitions inside the department, health care facility -19 min

2. unproduced time personally necessary time

· meal - 50 min

· short rest -26 min emergency conditions ytroglycerin - 1-2 tablets under the tongue, at the same time non-narcotic analgesics are administered intravenously in 20 ml of 5% glucose solution (analgin - 2-4 ml of 50% solution, baralgin - 5 ml, maxigan - 5 ml) in combination with minor tranquilizers (seduxen - 2−4 ml) or antihistamines (diphenhydramine - 1−2 ml of 1% solution), which enhance the analgesic effect and have a sedative effect. At the same time, the patient takes 0.2−0.5 g of acetylsalicylic acid, preferably in the form of an effervescent tablet (for example, anapirin).

If the pain syndrome is not relieved within 5 minutes, then immediately begin intravenous administration of narcotic analgesics (morphine hydrochloride - 1-2 ml of 1% solution, promedol - 1-2 ml of 1% solution, etc.) in combination with tranquilizers or neuroleptic droperidol (2-4 ml of 0.25% solution). The most powerful effect is exerted by neuroleptanalgesia (narcotic analgesic fentanyl - 1-2 ml of 0.005% solution in combination with droperidol - 2-4 ml of 0.25% solution).

After stopping the anginal attack, it is necessary to do an ECG to exclude acute myocardial infarction. Emergency care for myocardial infarction begins with immediate relief of the anginal status. Pain not only causes severe subjective sensations and leads to an increase in the load on the myocardium, but can also serve as a trigger for the development of such a formidable complication as cardiogenic shock. Anginal status requires immediate intravenous administration of narcotic analgesics in combination with antipsychotics and tranquilizers, since conventional analgesics are ineffective.

1. Antiplatelet (thrombolytic): acetylsalicylic acid (150-300 mg intravenously or orally) or ticlide (0.25 g 2 times a day).

2. Anticoagulants: heparin, fraxiparin.

3. Nitroglycerin is administered intravenously as follows: an isotonic sodium chloride solution is added to a 1% ampoule solution to obtain a 0.01% solution and administered dropwise at a rate of 25 mcg per 1 minute (1 ml of a 0.01% solution in 4 minutes).

4. Beta-blockers: anaprilin (propranolol) - 10-40 mg 3 times a day, or vasocardin (metoprolol) - 50-100 mg 3 times a day, or atenolol - 50-100 mg 3 times a day.

5. Angiotensin-converting enzyme inhibitors: capoten - 12.5−50 mg 3 times a day.

If less than 6 hours have passed since the onset of myocardial infarction, intravenous administration of actilise is very effective. This drug promotes thrombus lysis.

Combinations of drugs used in the treatment of pain in acute myocardial infarction:

· the most widely used is neuroleptanalgesia, which has a powerful analgesic and anti-shock effect, which is carried out by the combined administration of 1-2 ml of 0.005% fentanyl solution and 2-4 ml of 0.25% droperidol solution; instead of fentanyl, you can use morphine hydrochloride (1-2 ml of 1% solution), promedol (1-2 ml of 1% solution), omnopon (1-2 ml of 1% solution), etc.;

· an effective combination of narcotic analgesics (morphine hydrochloride - 1-2 ml of 1% solution, promedol - 1-2 ml of 1% solution), minor tranquilizers (seduxen - 2-4 ml) and antihistamines(diphenhydramine - 1−2 ml of 1% solution);

· anesthesia with a mixture of nitrous oxide and oxygen is currently used mainly by ambulance teams.

It is recommended to administer the drugs slowly intravenously. They are first diluted in 5-10 ml of isotonic sodium chloride solution or 5% glucose solution. Until the pain syndrome is completely relieved, which often requires repeated administration of analgesics, the doctor cannot consider his task completed. Other therapeutic measures, which are carried out simultaneously or immediately after pain relief, should be aimed at eliminating emerging complications (rhythm disturbances, cardiac asthma, cardiogenic shock). For uncomplicated myocardial infarction, drugs are prescribed that limit the area of necrosis (nitrates, beta blockers, thrombolytics).

Cardiogenic shock: emergency care

· Providing the patient with complete rest;

· Hospitalization is required, but in case of cardiogenic shock of II-III degree, measures to get out of it are first necessary.

· Transportation to the intensive care unit in a special car by a cardiology ambulance team, which will be able to carry out resuscitation measures along the way.

Cardiogenic shock: emergency care, special measures

· Administration of narcotic analgesics.

· 1% mesaton solution intravenously. At the same time, cordiamin, a 10% caffeine solution, or a 5% ephedrine solution is injected intramuscularly or subcutaneously. These drugs can be re-administered every 2 hours.

· A fairly effective remedy is a long-term intravenous drip infusion of a 0.2% norepinephrine solution.

· Intravenous drip administration of hydrocortisone, prednisolone or urbazone.

· It is possible to relieve a pain attack using nitrous oxide.

· Oxygen therapy;

· For bradycardia, heart block, atropine and ephedrine are administered;

· For ventricular extrasystole - intravenous drip of 1% lidocaine solution;

· Electrical defibrillation of the heart is performed in cases of ventricular paroxysmal tachycardia and ventricular fibrillation. For heart block - electrical stimulation.

· Connection to a ventilator, artificial circulation.

First aid for pulmonary edema At this time, it is very important to act quickly and accurately, since without support the situation can worsen sharply.

1. Before the ambulance arrives, people who surround the patient should help him take a half-sitting position so that he lowers his legs from the bed. This is considered the best pose for freeing the breathing of the lungs: at this time the pressure on them is minimal. The legs need to be lowered in order to relieve the pulmonary circulation.

2. If possible, suction the mucus from the upper respiratory tract.

3. It is necessary to provide maximum access to oxygen by opening the window slightly, since oxygen starvation may occur.

When the ambulance arrives, all specialists’ actions will be aimed at three goals:

· reduce the excitability of the respiratory center;

· relieve the load on the pulmonary circulation;

· remove foaming.

In order to reduce the excitability of the respiratory center, the patient is administered morphine, which relieves not only pulmonary edema, but also an asthma attack. This substance is unsafe, but here it is a necessary measure - morphine selectively affects the brain centers responsible for breathing. Also, this medication makes the blood flow to the heart less intense and due to this, congestion in the lung tissue is reduced. The patient becomes much calmer.

This substance is administered either intravenously or subcutaneously, and its effect begins within 10 minutes. If the blood pressure is low, promedol is administered instead of morphine, which has a less pronounced but similar effect.

Strong diuretics (for example, furosemide) are also used to relieve pressure.

To relieve the pulmonary circulation, they resort to a dropper with nitroglycerin.

If there are symptoms of impaired consciousness, the patient is given a weak antipsychotic.

Along with these methods, oxygen therapy is indicated.

First aid for colopse

Peace. Horizontal position with legs elevated, heating pads to arms and legs. If there is bleeding, take measures to stop it.

First aid

Hot tea, coffee. Intramuscularly 1 ml of 1% mesatone solution, 2 ml of cordiamine.

Medical emergency care

Medical station

Intravenously slowly 1 ml of 1% mesatone solution or 50-150 mg of prednisolone in 10-20 ml of 0.9% sodium chloride solution or in 10-20 ml of 40% glucose solution. If there is no effect, intravenous drip of 3-5 ml of 4% dopamine solution in 200-400 ml of 5% glucose solution or 2 ml of 0.2% norepinephrine solution in 400 ml of 5% glucose solution under blood pressure control. Intravenous polyglucin (reopoliglucin) 400 ml, 5% glucose solution - 400 ml.

First aid for fainting

As the very first medical aid for fainting, it is necessary to lay the patient on his back and slightly raise his legs. Free your neck and chest from restrictive clothing.

Patients should not be seated, as this makes it difficult to relieve cerebral ischemia, which is the basis of fainting.

In most cases, fainting lasts only 10-15 seconds and is usually not a sign of serious disorders. However, you should definitely consult a doctor. In most cases, fainting can be prevented or alleviated using available remedies.

According to medical statistics for 2014, 1101 cases of acute myocardial infarction per 100 tons of population were registered in the Republic of Kazakhstan. death from AMI in the Republic of Kazakhstan per 10 tons of population 33.6% mortality from AMI in the Republic of Kazakhstan per 100 tons of population 11.2

Prevalence of cardiovascular disease among patients (%)

The conclusion from this diagram is that over the course of several years we have seen a decrease, but still more people suffer from myocardial infarction, which leads to poor circulation than other heart diseases, and so for 2014, circulatory disorders are in first place, atherosclerotic plaques are in second place, and atherosclerotic plaques are in third place. coronary insufficiency, myocardial infarction in fourth place, ischemic disease in fifth place Digital indicators of medical procedures and manipulations performed by a nurse in the emergency cardiology department for 2014

From the table above it can be seen that a large number of medical manipulations are carried out over time, such as: counting the pulse, measuring blood pressure, taking an ECG due to cardiac pathology that requires active monitoring and treatment. In her work, the nurse is guided by the “Code of Ethics of Russian Nurses” as a basis which provides a detailed understanding of the patient's rights.

According to the code, a nurse must show respect for the life, dignity and human rights of each patient, regardless of nationality, race, skin color, age, or social status. At all stages of treatment, it is necessary to treat patients sensitively and attentively, as conscientious fulfillment of their care responsibilities, human participation helps them in the fight against the disease. Therefore, medical workers should provide moral support for successful treatment. Conducted a survey among patients who visited the clinic and inpatient cardiology clinic for hypertension and MI. Respondents were asked to fill out a questionnaire containing questions about hypertension and MI, the regularity of treatment and compliance with recommendations, the attitude of the medical staff of the cardiology clinic and clinic 3. The developed questionnaire included a number of questions to assess ideas about the factors influencing the prognosis of MI and hypertension, awareness of risk factors, the need for diets and doctor’s recommendations, the attitude of medical personnel, as well as sources of information on how to measure blood pressure, pulse, and nitroglycerin intake.

123 patients participated in the survey, including 3 outpatient clinics and a cardiology clinic.

Table 2

Prevalence of myocardial infarction by age

Distribution of myocardial infarction by body weight (%)

Conclusion: from the diagram we see that the main percentage of myocardial infarction incidence occurs in overweight patients

Conclusion: from this diagram we see that the population is not sufficiently informed about their disease

78% of surveyed patients with MI and only 39% of patients with arterial hypertension responded that they were treated regularly. Regular compliance with the doctor’s recommendations every month preceding the survey. The reasons for not following doctors’ recommendations are presented in the table

When analyzing the reasons for the irregular implementation of the recommendations of doctors with hypertension, it turned out that the most common problem is lack of awareness about the need for antihypertensive therapy; 61%, due to fear of side effects and the danger of addiction, do not follow the recommendations of doctors. Financial difficulties were cited by 13% of patients as the reason for irregular implementation of doctors’ recommendations.

During the survey, a patient with arterial hypertension and myocardial infarction, it was proposed to determine how factors such as age, smoking, body weight, sedentary lifestyle, stress, excessive consumption table salt, alcohol abuse, family history of cardiovascular diseases and accelerate the development of complications Factors that worsen the course of arterial hypertension and acute myocardial infarction and accelerate the development of complications (patients’ opinion)

It turned out that 68% of patients with hypertension believe that blood pressure increases with age, 23% of patients with hypertension and 30% of patients with MI know that smoking has an adverse effect on the course of the disease. Overweight the risk factor was noted by 50% of patients with hypertension and only 17% with it; the majority of patients with Blood pressure noted an adverse effect on the course of the disease - stress 81% and a sedentary lifestyle; 62% of patients with myocardial infarction attach less importance to these factors (corresponding to 17% and 35%), but the presence of diabetes mellitus as a factor worsening the prognosis of MI was noted by 57%. The resulting discrepancy in assessing the importance of such risk factors as diabetes mellitus and high blood cholesterol in patients with hypertension and AMI can be explained by the fact that patients with hypertension are significantly smaller informed about their own factors risk. When processing the questionnaires, it turned out that 61% of patients with hypertension and only 17.4% of patients with AMI would like to receive more information about their illness from their attending physician. Only 51% of patients with hypertension and 91.3% of patients with AMI know what hell is like. 69% of patients with hypertension and 65.2% of patients with AMI know their own weight. Awareness of blood glucose levels is 56.6% in patients with AMI and 34% in patients with hypertension

Based on this questionnaire, I also considered a question that included “do you follow the diet prescribed by your doctor?” below is a diagram and table number (survey 3 was conducted from clinic 3 with 25 patients and a cardiology clinic with 20 people.

According to this table, we see that 20 people answered that they follow the diet, and 25 patients answered that they do not follow it because they do not know. This means there was not enough information to tell the patient how to follow a diet, most of all it was shown in the cardiology clinic, which means the conversation was not held there. A table for assessing the work of medical staff with patients, the survey was conducted in polyclinic 3 and the cardiology clinic

Conclusion: the attitude of clinic 3 towards patients is better than that of a cardiology clinic. To my further questions, they answered that they receive information and politeness from the third clinic, some answered from the cardiocenter that they do not talk at all and do not explain the course of manipulations.

Based on this survey, some more questions were asked: do you know how to measure blood pressure, pulse, use nitroglycerin, maintain a physical regime, a table is given (number 5 with a diagram) they were interviewed both in the third clinic and in the cardiology clinic

It turns out that the people surveyed know how to measure blood pressure, pulse, maintain physical activity and take medications, of which they answered the question no, which means either the patients don’t know how or don’t want to know, and several patients also answered that they are not sufficiently informed and want to know about the information on how to measure , how to count, how much nitroglycerin to take, and how to maintain physical activity

Conclusion About 15-20% of patients with myocardial infarction die in the prehospital stage, another 15% die in the hospital. The overall mortality rate for myocardial infarction is 30-35%. Most of the hospital mortality occurs in the first two days, so the main treatment measures are carried out during this period. Controlled trials have shown that restoring perfusion during the first 4-6 hours of myocardial infarction helps limit its size, improve local and global contractility of the left ventricle, reduce the incidence of hospital complications (heart failure, pulmonary embolism, arrhythmias) and mortality. Restoring perfusion during the first 1-2 hours of myocardial infarction is especially beneficial. Late restoration of perfusion is also accompanied by increased survival, which is associated with improved myocardial healing and a decrease in the incidence of arrhythmias (but not limited infarct size).

When treating a pre-infarction condition, the nurse’s task is to relieve the pain syndrome, after which it is imperative to monitor vital functions in the therapeutic hospital, where he will undergo heparin therapy. Bed rest is absolutely required.

The most common tactical mistake of medical workers is those cases when patients in a pre-infarction state continue to work, they are not prescribed bed rest and adequate treatment.

Prevention of coronary heart disease (CHD) should begin as early as 35-40 years of age (and if there is a hereditary burden, even earlier) and should be carried out by eliminating risk factors whenever possible (the so-called primary prevention) and eliminating changes that have already occurred in organs caused by vascular atherosclerosis (so-called secondary prevention). The Institute was created in 1982 in Moscow preventive cardiology solves scientific and methodological issues of prevention of coronary artery disease.

It is recommended, if possible, to eliminate nervous tension, regulate intra-family and work relationships, and eliminate unpleasant experiences. It has been established that “people of a hypochondriacal character, who easily fall into a bad mood, are overly touchy, and cannot plan time for work and rest, are more likely to develop myocardial infarction.

Rational physical activity is of the utmost preventive importance: daily walking, jogging, cycling, swimming in the pool. nurses must persistently promote the benefits of physical activity, which improves blood circulation in the myocardium and extremities and activates the body's anticoagulant system.

For uncomplicated ischemic heart disease, it is recommended to exercise in such a way that the pulse rate increases by no more than 80% of the background, i.e. for people 50-60 years old when doing physical exercise it does not exceed 140 per minute, for 60-65 year olds - - no more than 130 per minute. Systolic blood pressure should not increase above 220 mm Hg. Art., and diastolic - no more than 10 mm Hg. Art. from the background. In all cases, a doctor should clarify the physical activity regimen.

The diet for IHD should be low-calorie - about 2700 kcal/day and for obesity - no more than 2000 kcal/day (proteins 80-90 g, fats 70 g, carbohydrates 300 g). Animal fat is limited in the diet (no more than 50%), refractory fats are excluded - beef, pork, lamb and fiber-rich foods - jelly, brains, liver, lungs; products made from butter dough, chocolate, cocoa, fatty meat, mushroom and fish broths are excluded, potatoes and sugar are limited (no more than 70 g per day). The use of xylitol and fructose, the introduction of vegetable oils, cottage cheese and other dairy products, cabbage, and seafood in the form of salads into the diet are recommended. Recommended fasting days. The content of table salt in food should be reduced to 4-5 g. Patients with coronary artery disease are not recommended to take more than 5-6 glasses of liquid per day. Smoking and drinking alcohol are prohibited.

Much awareness-raising work is needed to combat overnutrition and to prevent and treat obesity -- the most important factor risk of ischemic heart disease.

REFERENCES myocardial infarction treatment care

1. Management of patients at the prehospital stage//A. L. Vertkin, A. V. Topolyansky, V. V. Gorodetsky and others - M.: National Scientific and Practical Society of Emergency Medical Care, department clinical pharmacology and internal diseases MGMSU, //Doctor.Ru, 9, 2003

2. Smoleva E. V., Stepanova L. A. IHD. Acute myocardial infarction.//Pocket reference of a paramedic.-M., 2003, -289 p.

3. Syrkin A. L. Myocardial infarction. -M.: Medical Information Agency, 2003.

4. Fadeeva T. B. Paramedic Handbook: Emergency Care. - M.: Modern Writer, 2008 - 288 p.

5. Yavelov I. S., Gratsiansky N. A. Acute myocardial infarction.// In the world of drugs, 2, 1998.

6. Gritsyuk. A.I. and others “myocardial infarction” / A. I. Gritsyuk, N. A. Gvatua, I. K. Sledzevskaya.

7. Dolyuachyan Z. L. “Myocardial infarction and electromechanical activity of the heart”

8. Ryabov S., I. “Care for patients with cardiovascular diseases

9. modern medical encyclopedia of St. Petersburg. "lawyer".2002.

10. reference book for a practicing physician. In two books. M.: Peace and Education 20.03.

11. magazine “nurse” No. 6 - 2001

12. Kobalava Zh. D. Russian scientific and practical program ARGUS “improving the detection, assessment and treatment of arterial hypertension in patients over 55 years old”\ current issues arterial hypertension. 2000. No. 1. P. 7−11

QUESTIONNAIRE

1. how old are you?

2. How much do you weigh?

3. Do you have diabetes A. yes B. No C. don’t know

4. Did your guardians have any trouble with him or her?

A. yes B. no C. I don’t know

5. Do you know about your disease?

6. Do you know the reason for the development of myocardial infarction?