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Essentials of Diagnosis:
Angina may radiate to any dermatome from C8 to T4; most often, it radiates to
the left shoulder and upper arm, frequently moving down the inner volar aspect of
the arm to the elbow, forearm, wrist, or fourth and fifth fingers.
Occasionally, it may be felt initially in the lower jaw, back of the neck, the
interscapular area, high in the left back, or in the volar aspect of the wrist.
Duration of attacks:
Effects of nitroglycerin
Risk factors
Signs
Gallop rhythm.
Differential diagnosis:
Spontaneous pneumothorax
Pulmonary embolization
Laboratory findings:
Electrocardiography:
Exercise ECG:
Indications:
Confirm diagnosis of angina.
Echocardiography
Coronary angiography
Patients with aortic valve disease who also have angina pectoris.
Treatment
Acute attack:
Sublingual nitroglycerin
Aggravating factors
Platelet-inhibiting agents
Risk reduction
Revascularization
Indications:
Left main coronary stenosis greater than 50% with or without symptoms.
Unstable angina
Post-MI patients.
Types:
Essentials of Diagnosis:
Clinical Findings
Symptoms:
Premonitory pain
Pain of infarction
Associated symptoms:
Light-headedness, syncope
Abdominal bloating
Nausea
Painless infarction
General:
Respiratory distress
Chest:
Heart:
Transient murmurs
Extremities:
Laboratory findings:
Electrocardiography:
Peaked T waves
T wave inversion
Q waves
Chest x-ray
Echocardiography
Scintigraphic studies
Hemodynamic measurements
Treatment
Thrombolytic therapy:
o t-PA
o Streptokinase / urokinase
o Anisoylated plasminogen streptokinase activator complex (APSAC)
Anti-platelet drugs
Acute PTCA
General measures:
o CCU monitoring
o Bed rest
o Progressive ambulation after 24 to 72 hours
o Low-flow oxygen therapy and liquid diet (1 st 24 hours)
Analgesia
Antiarrhythmia prophylaxis
Beta-adrenergic blocking agents
Nitrates
ACE-inhibitors
Calcium-entry blocking agents
Anticoagulation
A. PREDISPOSING FACTORS
1. Microbial invasion
E. coli
Streptococcus
2. Urinary retention/ stagnation
3. pregnancy
4. DM
5. Exposure to renal toxins/ use of nephrotoxic agents
6. Obesity
B. S/SX
1. Acute Pyelonephritis
Urinary frequency and urgency
Costovertebral angle pain and tenderness
Fevers and chills, anorexia, general body malaise
Burning upon urination
Dysuria, nocturia, hematuria
2. Chronic Pyelonephritis
Fatigue and/or weakness
Weight loss
Polyuria
Polydypsia
HPN
C. DIAGNOSTICS
1. Urine CS: (+) cultured microorganisms (E.coli and strep)
2. Urinalysis: elevated WBC, CHON, pus cells
3. Cystoscopic exam: (+) urinary obstruction
NURSING MANAGEMENT
1. Provide CBR especially during acute attack
2. Forced fluids
3. Provide an acid ash in the diet
4. Provide warm sitz bath for comfort
5. Administer medications as ordered
Nitrofurantoin
SE: GIT irritation, give with food, peripheral neuropathy, hemolytic anemia (initial sx:
fever), discoloration of teeth
Urinary analgesics
Pyridium
6. prevent complications
renal failure
NEPHROLITHIASIS/UROLITHIASIS formation of stones elsewhere in the urinary
tract
TYPES OF STONES
1. calcium
2. oxalate
3. uric acid
B. PREDISPOSING FACTORS
1. diet high in calcium and oxalate
2. hereditary (like gout)
3. hyperparathyroidism (Hypercalcemia)
4. obesity
5. sedentary lifestyle
C. S/SX
1. Renal colic
2. Cool, moist skin
3. Burning upon urination
4. Dysuria, Nocturia
5. Hematuria
D. DIAGNOSTICS
1. Urinalysis (+) RBC, WBC, Pus cells
2. KUB: reveal site or location of stones
3. Stone analysis: reveals composition of stone
4. Cystoscopic exam: urinary obstruction
5. IVP: reveals obstruction
E. NURSING MANAGEMENT
1. Forced fluids to prevent further crystallization
2. Alternate warm and cold compress
3. Administer isotonic fluids as ordered
4. Strain all urine using gauze pad
5. Warm sitz bath for comfort
6. Meds as ordered
Narcotic analgesics morphine
Allopurinol (zyloprim)
7. Provide dietary intake:
If (+) to ca stones: acid ash
If (+) to oxalate stones: alkaline ash (milk, tea, vegetables)
If (+) to uric acid: avoid purine rich food like anchovies, legumes, organ meat, nuts
8. Assist
Litholapoxy surgical removal of 2/3 stone
Nephrectomy removal of kidney stagnation
Lithotripsy extracorporeal shockwave
No incision, early discharge
Too costly
Stones can recur
Post-op: strain urin
9. Prevent complications renal failure