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Arthritis patient problem

28 Sep 18

potential patient problem with rheumatoid arthritis

Complications of rheumatoid arthritis (RA)

When you think of rheumatoid arthritis (RA), you probably only think of inflammation and painful stiffness in your joints. which, in fact, characterize the disease. But you may not know that RA comes with complications. An autoimmune inflammatory process that causes joint destruction can also cause eye damage. lungs, skin. heart, blood vessels and many other organs. And also medicines. medications you take to treat RA may have unwanted side effects. In addition, with any chronic disease you are subject to emotional distress every day, and many people with RA suffer from depression.

In order to cope with the complications of rheumatoid arthritis, it is important to identify the problem early and receive appropriate treatment.

Here are some potential problems you need to be aware of:

About a fifth of people with rheumatoid arthritis develop so-called rheumatoid nodules - localized lumps in the soft tissue, usually under the skin, especially on the elbows, forearms, heels or toes. These nodules may develop gradually or appear unexpectedly, which may indicate a transition to a more severe, active form of the disease. Rheumatoid nodules can also form in other organs, such as the lungs or heart.

The inflammation of the blood vessels that accompanies RA, or vasculitis, can lead to changes in the skin and surrounding tissue that may become ulcerated.

Patients may also experience rashes and other skin changes, both due to RA and the medications they are taking. And that’s why it’s so important to warn your doctor about any such changes.

^ 4.2.1 Nursing process in atherosclerosis.

Causes, predisposing factors of atherosclerosis.

Reasons contributing to the development of hypertension.

Symptoms of hypertension.

Definition of chronic failure. Mechanism. Stages.

Clinical manifestations of atherosclerosis.

Problems of patients with hypertension and features of their solution.

Clinical manifestations, symptoms and syndromes of CNC.

Problems of patients, features and difficulties of solving them in atherosclerosis.

Symptoms that make it possible to recognize a hypertensive crisis, the actions of the nurse and their rationale.

Problems of patients with chronic heart failure.

Principles of treatment, prevention, dietary features for hypertension.

List of examinations, preparation of patients for examinations for diseases of the cardiovascular system.

Features of nursing care when solving the problems of a patient with CNC.

Diet for atherosclerosis.

Principles of treatment. The main groups of drugs used for CNC.

Problems of patients with atherosclerosis of the aorta and coronary arteries.

Prevention of CNC. The role of the nurse in correct recommendations for taking medications, diet, and regimen after discharge from the hospital.

Characteristics of the main groups of drugs used for CNC.

Risk factors for the development of pressure ulcers.

^ 4.3.1 Nursing process for angina pectoris.

Definition of IHD. Social significance of IHD in Russia.

Definition of myocardial infarction. Causes.

Etiology of IHD. Risk factors.

Clinical manifestations of myocardial infarction: leading syndromes in typical and atypical forms of myocardial infarction.

Angina pectoris. Causes. Clinical manifestations. Main syndromes.

Current, priority and potential problems of patients with myocardial infarction, ways to implement them.

Problems of patients with angina pectoris and features of their solution.

Complications of the acute period of myocardial infarction, information that allows one to establish a life-threatening condition and develop actions for emergency first aid.

Rituximab in modern therapy of rheumatoid arthritis

Research Institute of Rheumatology RAMS, Moscow

The problem of treating rheumatoid arthritis (RA) is discussed. Modern concepts concerning the pathogenesis and methods of treatment of this serious disease are covered. Modern genetically engineered biological drugs used for the treatment of RA are considered. including tumor necrosis factor inhibitors. (TNF-alpha), as well as a group of chimeric monoclonal antibodies, the main focus of which is rituximab. A review of studies assessing the effectiveness of rituximab for the treatment of patients with RA is given, the results of which allow us to consider this drug as worthy of widespread practical use and actively competing with TNF-alpha inhibitors.

Rheumatoid arthritis (RA) remains important as one of the most important problems in scientific and practical rheumatology. The disease is characterized by widespread prevalence (about 1% of the population), persistent progressive course, complex pathogenetic mechanisms, and heterogeneity of clinical and immunological forms. In the absence of adequate treatment, patient disability may occur in the first years of the disease. Due to potentially dangerous systemic manifestations and complications (vasculitis, amyloidosis, etc.), as well as the accelerated development of atherosclerosis and the high incidence of severe cardiovascular pathology, patients with RA experience a decrease in life expectancy compared to the general population by 3–7 years [1, 2] . All these factors make RA therapy a major challenge.

For a long time, RA was considered a steadily progressive disease, the course of which is extremely difficult to control. Since the mid-1990s. Significant changes have been observed in approaches to the treatment of RA, which have led to a significant improvement in prognosis.

The following strategically important concepts were substantiated [3, 4]:

Rheumatoid arthritis. Symptoms, treatment

Rheumatoid arthritis is a chronic inflammatory disease that usually affects the small joints in the hands and feet. A rheumatologist diagnoses and treats rheumatoid arthritis. Rheumatoid arthritis belongs to a group of autoimmune diseases (when the immune system mistakenly attacks the tissues of its own body). Rheumatoid arthritis affects the lining of the joints, causing painful swelling and can eventually lead to bone erosion and joint deformity.

In addition to joint damage, rheumatoid arthritis may cause increased body temperature and general weakness. In some cases, rheumatoid arthritis sometimes affects organs outside the joints, such as the skin, eyes, lungs, heart, blood, nerves, or kidneys.

Rheumatoid arthritis is more common in women than men and usually occurs between the ages of 40 and 60. Rheumatoid arthritis affects everyone differently. For most people, joint symptoms may develop gradually over several years. In other patients, rheumatoid arthritis may progress rapidly. Treatment is aimed at reducing or controlling symptoms and preventing joint damage

Symptoms of rheumatoid arthritis .

Symptoms of rheumatoid arthritis may include:

  • Pain, swelling, increased temperature in the affected joints;
  • Morning stiffness in the joints, which can last for several hours;
  • The presence of rheumatoid nodules under the skin on the hands;
  • General weakness, fever and weight loss.
  • Most often, in the early stages, rheumatoid arthritis affects the small joints of the hands and feet (metatarsophalangeal and metacarpophalangeal). As the disease progresses, symptoms often spread to the knees, elbows, hips and shoulders. In most cases, symptoms occur symmetrically, in the same joints on both sides of the body. This symmetry sometimes helps differentiate rheumatoid arthritis from other types of arthritis.

    The reasons causing the development of rheumatoid arthritis have not been reliably established. The hereditary nature of disturbances in immunological responses and the role of infectious etiofactors (Epstein-Barr virus, retrovirus, cytomegalovirus, mycoplasma, herpes virus, rubella, etc.) have been determined.

    The basis of the pathogenesis of rheumatoid arthritis is autoimmune reactions that develop in response to the action of unknown etiological factors. These reactions are manifested by a chain of interconnected changes - inflammation of the synovial membrane (synovitis), the formation of granulation tissue (pannus), its growth and penetration into cartilaginous structures with the destruction of the latter. The outcome of rheumatoid arthritis is the development of ankylosis, chronic inflammation of the periarticular tissues, contracture, deformation, and subluxation of the joints.

    Classification of rheumatoid arthritis

    According to clinical and anatomical features, forms of rheumatoid arthritis are distinguished:

  • occurring as polyarthritis, oligo- or monoarthritis;
  • characterized by systemic symptoms;
  • combined with diffuse connective tissue diseases, deforming osteoarthritis. rheumatism;
  • special forms (juvenile arthritis, Still and Felty syndromes)
  • According to immunological characteristics, there are seropositive and seronegative variants of rheumatoid arthritis, which differ in the detection or absence of rheumatoid factor in serum and joint fluid.

    The course of rheumatoid arthritis can vary. The rapidly progressing variant is characterized by high activity: erosion of bone tissue, deformation of joints, systemic lesions during the 1st year of the disease. Slowly developing rheumatoid arthritis, even many years later, does not cause gross morphological and functional changes in the joints and proceeds without systemic involvement.

    Based on the activity of clinical and morphological changes, three degrees of rheumatoid arthritis are differentiated.

    Patient problems with atherosclerosis

    Potential patient problem with renal artery atherosclerosis

    Prevention of atherosclerosis includes

    a) physical education classes

    c) sanitation of chronic foci of infection

    Main cause of coronary heart disease

    Atherosclerosis is a disease with a chronic course, which is characterized by damage to arteries of the muscular-elastic and elastic type, which occurs as a result of impaired fat metabolism, accompanied by the deposition of cholesterol plaques on the inner wall of blood vessels. Such deposits are called atheromatous plaques. Subsequently, they undergo sclerosis and calcification, which further worsens the condition of the vessels (they become deformed and their lumen becomes greatly narrowed).

    The pathogenesis of atherosclerosis consists of several stages.

    Modern ideas indicate that the disease develops on the basis of many factors, which, when combined, give rise to the formation of fibrous foci, without complications and with complications.

    The pathogenesis of atherosclerosis is complex; it includes the following stages:

  • the stage of lipoidosis, marked by the formation of lipid streaks and spots;
  • liposclerosis, or the formation of foci of fibrosis;
  • the sclerotic plaque becomes more complicated.
  • The first stage of the disease is characterized by the formation of stripes and spots of lipids on the inner wall of blood vessels. Yellowish spots ranging in size from 1 to 1.5 mm appear on the surface of the intima of the aorta and arteries. The main components of lipid spots are foam cells, which contain a large amount of lipids, T-lymphocytes, some macrophages, and smooth muscle cells.

    Over time, the spots grow in size, they tend to merge with each other to form lipid strips, and slightly rise above the surface of the blood vessels.

    Cholesterol at this stage is predominantly located inside cells.

    Since lipids are deposited in the inner lining of large vessels, dysfunction of the latter soon occurs. The pathology is characterized primarily by damage to the endothelium; the permeability of this layer of the vascular wall increases (pictures depicting the process of formation of pathological foci are shown below).

    Damage to the endothelium is accompanied by atherosclerosis, the reasons may be different.

  • Turbulent flow creates conditions for mechanical damage to the endothelium.
  • Increased pressure increases shear stress.
  • Atherogenic lipid fractions and lipoproteins, especially those that have undergone peroxidation and glycosylation, that is, modified forms, have a strong cytotoxic effect.
  • Catecholamines and angiotensin 2, produced by increasing the activity of the renin-angiotensin system and the sympatho-adrenal component, have a damaging effect on the vascular endothelium.
  • The disease may be a consequence of a decrease in oxygen concentration in the blood, that is, any chronic hypoxemia and hypoxia.
  • Smoking is one of the main risk factors and significantly aggravates the course of the disease.
  • Deficiency of certain vitamins, such as B6, B12, folic acid, which is accompanied by an increase in homocysteine ​​in the blood.
  • Some infections based on chronic inflammation of the vascular wall (some viruses and chlamydia).
  • Endothelial dysfunction is accompanied by decreased production of factors that reduce vascular tone (nitric oxide, prostacyclin) and increased synthesis of vasoconstrictors (thromboxane 2A, endothelin).

    Lipoproteins and low-density lipoproteins, as well as cellular elements that have penetrated into the intima of arteries and veins, undergo a process of oxidation and glycosylation. This further damages the endothelium and promotes the penetration of cellular elements from the blood into the intima of the arteries.

    Monocytes in the intima change into macrophages and ingest modified low-density lipoprotein and cholesterol.

    During the course of the disease, there is a peculiarity - the formation of foam cells.

    These macrophages, full of lipids, are called foam cells. Together with platelets, they produce mitogens and growth factors, under the influence of which smooth muscle cells migrate into the vascular intima and begin to proliferate. They also go through a process of becoming foam cells. As a result, smooth muscle cells begin to produce glycosaminoglycans, elastin and collagen, which serve as a fibrous scaffold for the atherosclerotic plaque. The process of apoptosis destroys foam cells, and the lipids contained in them move into the extracellular space.

    Further stages of atherosclerosis occur with the formation of plaques.

    The areas where lipid deposition occurred gradually undergo sclerosis. The process ends with the formation of fibrous foci with a core. As a result of apoptosis, cells overloaded with lipids contribute to an increase in their extracellular levels. Lipids form a core of atheromatous masses (lipid-protein detritus). The lipid core is surrounded by connective tissue.

    Sclerotic lesions are overgrown with newly formed vessels, they are prone to thrombus formation, their permeability is increased, and they often rupture. Over time, the number of cells around the sclerotic plaque decreases, and the connecting canal, on the contrary, grows, forming a “cover” that separates the lipid core from the lumen of the artery. Accordingly, a new fibrous plaque is formed, which disrupts blood flow in the vessels.

    Formation of complicated plaques

    The disease sometimes resolves with the formation of complicated lesions. It is characterized by a large size of the lipid core (about 30% of the total mass), the presence of hemorrhages, thinning of the plaque capsule and destruction of the covering with the formation of cracks, ruptures and ulcers.

    In this case, detritus enters the lumen of the vessel, which can cause an embolism, and new blood clots form on the surface of the ulcerated lesion.

    The disease at the last stage is the deposition of calcium salts into the plaque itself, the interstitial substance and fibrous tissue, that is, atherocalcinosis.

    Atherosclerosis is characterized by the formation of stable and unstable lesions. It depends on their size, shape, and structural features. The stability of plaques is characterized by their slow growth and relative staticity. They are rich in collagen fibers.

    The instability is due to their high saturation with lipids. Unstable elements of the disease are prone to frequent rupture, exposure of the endothelial surface and the formation of new thrombotic masses. The clot restricts or completely prevents normal blood flow in the artery. Clinically, this form of pathology looks like an unstable form of angina, stroke or heart attack, transient ischemic attack.

    The risk factors for atherosclerosis are different, so the disease is considered polyetiological:

  • pathological immune reactions, which are accompanied by damage to endothelial cells;
  • hypoxia of various origins;
  • the disease is aggravated by the entry of toxins into the blood (viral infections, bacterial intoxication, food poisoning, coma and shock);
  • homocysteine ​​synthesis;
  • dyslipoproteinemia of various origins (acquired, congenital, hereditary);
  • changes in blood pressure within significant limits, as well as changes in the speed of blood flow;
  • smoking from a young age;
  • In the origin of the disease, scientists identify the most significant factors, which are combined into theories.

  • Infiltration of the walls of arteries and veins with lipoproteins.
  • Dysfunction of endothelial cells (the function of cells of the endothelial layer is impaired, in particular the protective one, as well as the function of endothelial mediators).
  • Autoimmune mechanisms (the causes of atherosclerosis are the primary dysfunction of the cells of the macrophage system and leukocytes that infiltrate the vascular walls).
  • The monoclonal theory consists in the primary formation of a clone of pathological smooth muscle fibers.
  • Damage to the endothelium by viruses (cytomegalovirus, herpes).
  • Violation of antioxidant factors.
  • Genetic factor. Atherosclerosis becomes a secondary result of a hereditary defect of the vascular wall.
  • The disease is a consequence of chlamydial inflammation of the intima of blood vessels.
  • Hormones play a role in increasing the synthesis of sources for cholesterol (increased levels of corticotropic and gonadotropic hormones).
  • The nursing process for atherosclerosis consists of recognizing the patient's problems and taking professional measures on the part of nursing staff.

    Regarding the patient’s health, doctors identify the main problems:

  • the pathology is accompanied by dizziness and headaches;
  • pain in the lower leg muscles when walking;
  • shortness of breath appears after physical activity;
  • the patient is often bothered by pain in the sternum (from the heart);
  • The listed complaints are classified as disorders of the body’s physiology. But mental disorders are often characteristic:

  • frequent worries about the disease and its possible complications.
  • difficulties during the act of defecation.
  • The patient tends to distrust the drugs that the doctor prescribed to him; he does not believe in their effectiveness.
  • The first priority is headaches, which may indicate impaired blood circulation in the brain. The main problem for the patient is ignorance about the disease itself, the principles of therapeutic nutrition, the causes of the disease and its prognosis, and some people are not aware of the necessary medications.

    The nursing process for atherosclerosis includes certain actions of nursing staff.

  • In the first place are the rules for caring for a specific patient: change underwear and bed linen during the procedure, encourage the patient to comply with the prescribed diet, regularly ventilate the room, while avoiding the formation of drafts. The nurse also monitors the implementation of all the instructions of the attending physician and prepares the patient for various diagnostic examinations;
  • The nurse monitors medication intake, the patient’s compliance with diet and rest;
  • It is necessary to systematically conduct a conversation with the patient about what the disease is, about the necessary regular visits to a cardiologist, neurologist, as well as about the mandatory use of medications;
  • Considering the possibility of the development of discirculatory encephalopathy due to the disease and the subsequent loss of memory in the patient, the nurse should conduct a dialogue with his relatives and inform them about the prescribed treatment, the need to monitor medication intake and adherence to the rules of therapeutic nutrition.
  • Atherosclerosis can lead to severe life-threatening consequences.

    1. Embolism or arterial thrombosis are common complications of atherosclerosis. Obliterating atherosclerosis is in first place among the causes of thrombosis. The thrombus gradually grows on the intima of the arteries and eventually clogs its entire lumen. During the formation of a blood clot, the blood flow changes, turbulence and non-physiological flows occur, which further aggravates the disease and accelerates thrombus formation. Plaque rupture or hemorrhage into its thickness leads to the formation of a blood clot, and the result is myocardial infarction, ischemic stroke, and unstable angina. The disease is complicated by the formation of emboli. Peripheral embolism develops as a result of the disintegration of atheromatous masses into fragments and their movement from large-caliber vessels to smaller ones. Clinically, this is expressed in embolic stroke, embolism of the renal arteries with the formation of acute renal failure. Embolism with detrital masses develops spontaneously. This can occur during surgery, angiography, and thrombolytic therapy in individuals with a diffuse form of sclerotic lesions.
    2. Narrowing of the lumen of arteries and veins, calcification of their walls often complicate the course of the disease. It develops as a result of the progressive growth of a fibrous plaque, the formation of blood clots inside it and when hemorrhage occurs in the foci of atherosclerosis. The patient is bothered by intermittent claudication and may experience a heart attack.
    3. Loss of strength of vascular walls. The disease is accompanied by a gradual loss of tone of the arterial and venous beds. Growing foci of sclerosis put increasing pressure on the underlying medial layers of the arterial wall, which inevitably leads to their atrophy and loss of elasticity. The consequences are aneurysms, most often of the aorta.
    4. A common outcome of this type of arterial damage is gangrene of the extremities. The tissues of the toes die first and become dark or black. Gangrene is dangerous because a large amount of tissue breakdown products enters the bloodstream. The death of the patient may occur due to acute renal failure. Atherosclerosis is dangerous due to the development of wet gangrene, since it indicates the addition of a bacterial infection and the beginning of the process of rapid tissue decay.

      In such a situation, a patient needs urgent amputation of the affected limb.

      Critical tissue ischemia of the lower extremities is slightly different in its course. The tissues die gradually. The patient is bothered by constant pain, so regular pain relief is added to the treatment. The pathology is complicated by trophic ulcers or gangrene of the foot. Outwardly, the patient has a characteristic appearance: the sore leg is lowered, the expression on his face is pained, it is difficult for him to lie down, as the pain intensifies significantly. Constant pain provokes sleep disturbances, changes in mood up to depression, decreased appetite, and the disease exhausts the patient. Since this process is accompanied by inflammation, soft tissue swelling develops at the site of impaired blood supply, further aggravating microcirculation. The process is complicated by the development of non-healing ulcers and the appearance of areas of dead tissue. Lack of oxygen and nutrition in the tissues of the lower limb leads to inflammation of the sensitive nerve fibers, the patient feels unbearable pain. All drugs aimed at relieving pain bring short-term relief.

      Currently, medical school No. 13 is a modern, well-equipped state budgetary educational institution of secondary vocational education in Moscow . teaches students in the specialty 060501 “ Nursing ” in full-time and part-time departments, receiving secondary specialized education, qualification: Nurse/Nurse, duration of study on the basis of basic general education - 3 years 10 months, training is carried out in Russian. The founder of the school is the Moscow Department of Health >>.

      License - 77 No. 003847 issued on March 14, 2012 until - indefinitely.

      Andreevsky Vladimir Olegovich

      Help phone: 8 (499) 248-51-52

      Deputy Director for Practical Training

      Andreeva Lidiya Mikhailovna

      phone: 8 (499) 248-47-90

      Helpline 8 (499) 248-51-52

      The highly qualified teaching staff employs enthusiastic, dedicated specialists, including 4 candidates of science, 25 teachers of the highest and first qualification categories, as well as a group of young teachers. This team provides training for students in specialty 060501 “Nursing”.

      Among the teachers there are graduates of our school:

    5. Kiryakova Tatyana Nikolaevna – teacher of obstetrics and gynecology, graduate of 1962;
    6. Zdebskaya Anna Nikolaevna - teacher of nursing, disaster medicine, graduate of 1996;
    7. Snegireva Tatyana Genadyevna - teacher of the basics of massage, physiotherapy, rehabilitation, graduate of 1985;
    8. Anipchenko Ekaterina Vladimirovna - maintenance and safety engineer, graduate of 1981;
    9. Astashkina Tatyana Vladimirovna, social teacher, graduate of 2008;
    10. Dubinina Evgenia Vladimirovna, physical education teacher, graduate of 2010;
    11. Elagina Irina Pavlovna, head of a structural unit, graduate of 1978
    12. The backbone of the teaching staff consists of teachers who have worked at the school for a long time:

    13. Leonova Tamara Aleksandrovna – physical education teacher;
    14. Chistyakova Tatyana Ivanovna - PM teacher,
    15. Olga Mikhailovna Nesina – mathematics teacher,
    16. Shubnikova Lyubov Petrovna - psychology teacher,
    17. Zakharova Olga Borisovna - PM teacher,
    18. Shavlyuga Tatyana Mikhailovna - head of the structural unit,
    19. Zhigalova Natalya Vasilievna – head of the department of advanced training,
    20. Andreevsky Vladimir Olegovich – director,
    21. Zdebskaya Anna Nikolaevna - teacher of PM, disaster medicine,
    22. Abramova Irina Vladimirovna - PM teacher.
    23. Skripnik Natalya Sergeevna - teacher of PM.
    24. Drozdova Nadezhda Petrovna - supply manager,
    25. Teplyakov Vyacheslav Stepanovich - life safety teacher,
    26. Poleshko Irina Vasilievna - deputy. Director of Academic Affairs
    27. Anahit Borisovna Khachikyan – anatomy teacher
    28. The team maintains close ties with veterans who have spent many years working there:

    29. Levina Elizaveta Maksimovna,
    30. Gritseva Rimma Vladimirovna,
    31. Ovchinnikova Nina Isidorovna,
    32. Kruteleva Alevtina Fedorovna,
    33. Starikov Alexander Evgenievich,
    34. Yudina Tamara Fedorovna,
    35. Savonin Vladimir Pavlovich.
    36. Yashin Vladimir Nikolaevich,
    37. and many others, honors the memory of departed veterans, including directors, in the 50s - 80s - Anna Savelyevna Polyakova and Zinaida Grigorievna Kochneva.

      Graduates after graduating from college work in large medical and preventive institutions of the city and country (polyclinics, dispensaries, sanatoriums, clinics, maternity hospitals, rehabilitation centers) as operating rooms, guards, treatment rooms, ward nurses, after additional specialization they find their place in sports medicine, cosmetology, physiotherapy, etc.

      First of all, the school trains specialists for healthcare in the city of Moscow. Practical classes, which make up about 70% of the curriculum, are conducted on the basis of modern city clinics: Children's City Clinical Hospital No. 13 named after. N.F. Filatov (metro station "Mayakovskaya"), city clinical hospital No. 51 (metro station "Filyovsky Park"), city clinical hospital No. 61 (metro station "Sportivnaya"), city clinical hospital No. 64 (metro station "University" "), City Clinical Hospital No. 71 (Mozhaiskoe Highway), Bakulev Center for Cardiovascular Surgery, Research Oncology Institute named after. P.A. Herzen, city clinical hospital No. 31 (metro station "Prospekt Vernadskogo"), maternity hospital No. 6 (metro station "Belorusskaya"), clinics for adults and children

      Health departments of the Central, South-Western, Western administrative districts of the city.

      The clinical bases of the school are mostly staffed by nursing staff from school graduates, many of them work both in the Moscow outpatient clinic system and in large medical centers.

      Respiration rate_________________per minute;

      Head circumference______cm; Chest circumference_______cm;

      Inpatient (educational)

      Nursing card No. _________

      FULL NAME. student_________________________________group No._________________

      Specialty 060109 Nursing 51

      NURSING HISTORY OF AN INPATIENT

      Moscow City Health Department

      GBOU SPO Medical College No. 6

      Discipline: "Nursing in Pediatrics"

      Defense of the nursing history "________"

      Name of the Medical Organization_______________________________________________

      Date and time of receipt__________________________________________________________

      Date and time of checkout _______________________________________________________________

      Department __________________________________________ ward _________________________

      Transferred to department ______________________________________________________________

      Bed days spent _______________________________________________________________

      Types of transportation: on a gurney; on the armchair; can go (underline)

      Blood type ________________ Rhesus affiliation ___________________________________

      Side effects (intolerance) of drugs________________________________________

      (name of the drug, nature of the side effect)

      1. FULL NAME. patient ____________________________________________________________________

      2. Gender _________ 3. Age _________ ( full years, for children: up to one year _______ months, up to 1 month _______ days )

      4. Permanent place of residence (address)_________________________________________________

      5. Place of work, profession or position_____________________________________________

      (for students - place of study, for children the name of a child care institution, school)

      6. Who referred the patient___________________________________________________________

      7. Sent to hospital for emergency reasons: yes; no, ______ hours after the onset of the disease or injury; hospitalized as planned (underline)

      8. Medical diagnosis_________________________________________________________________

      9. Who will the child stay with in the hospital?_____________________________________________

      1. Purpose of hospitalization: treatment, rehabilitation (underline)

      2. The patient’s appearance: neat, untidy (underline)_______________________________________________________________________________

      3. Housing conditions, with whom he lives_________________________________________________

      · How it started __________________________________________________________________

      · When did it start ________________________________________________________________

    38. How it proceeded________________________________________________________________
      • Previous illnesses: injuries, fractures, severe infections, surgeries (underline)_________________________________________________
      • Allergic reactions:
      • · Heredity - the presence of the following diseases in blood relatives (underline): diabetes mellitus, obesity, etc.___________________________

        Body weight __________ kg; height ______________; BMI ______________________________

        Pulse: heart rate ______________________ per minute, regular, irregular (underline)

        Nursing care: patient problems during myocardial infarction

        Mortality from cardiovascular pathology ranks first in the world among all diseases. To successfully combat this formidable disease, it is necessary to clearly understand the patient’s problems with myocardial infarction and know the protocol for providing first aid to the patient. This pathological process is a violation of the patency of the coronary vessels and the formation of areas of necrosis in the heart muscle.

        Myocardial infarction often occurs in men aged 55–65 years, but recently this disease is rapidly becoming younger. This is due to increased psycho-emotional stress, abuse of bad habits and the constantly deteriorating state of the environment.

        The main causes of the development of pathology of the heart muscle

        In 90% of cases, the trigger for the formation of areas of necrosis in the myocardium is atherosclerosis of the coronary vessels of the heart. Due to various external and internal factors, the lumen of the arteries supplying the heart with blood is blocked by atherosclerotic plaques and salt compounds.

        In some cases, the cause of myocardial infarction is embolism in the vessels of the heart. Various inflammatory diseases of the cardiovascular system lead to this process: from obliterating endocarditis to nodular periarthritis.

        The cause of myocardial infarction can also be a congenital pathology. This disease develops when the patient has abnormal origins of the coronary vessels from the aorta and other heart defects. This happens extremely rarely; patients are identified in adolescence and do not affect the medical statistics of this heart disease.

        Risk factors for myocardial infarction include:

      • various diseases of the body (staphylococcal and streptococcal infections, rheumatic carditis, diabetes mellitus, obesity and hypertension);
      • social aspects of the occurrence of myocardial infarction (gender, age, alcoholism, smoking, lifestyle and environment);
      • the presence in the blood test of high levels of LDL cholesterol and low levels of HDL cholesterol;
      • An unconditional risk factor for the occurrence of cardiac muscle necrosis is the patient’s history of treated myocardial infarction and any other symptoms of atherosclerosis.
      • Post-infarction cardiosclerosis occurs quite often. He may have an aneurysm or ischemic heart disease. Recognizing symptoms and timely diagnosis will help save lives, and ECG signs will help establish the correct diagnosis. Treatment is lengthy, rehabilitation is required, and there may be complications, including disability.

        Classification and clinical manifestations of myocardial infarction

        In the medical literature, over more than 110 years of studying this pathology, a large number of classifications of cardiac muscle necrosis have accumulated. Experts systematize the clinical and laboratory manifestations of a heart attack by stages of development, anatomy of the affected areas, volume and depth of necrosis, course of the disease and localization of tissue breakdown processes in the heart muscle.

        However, for providing first aid and stabilizing the patient’s condition in the early stages of the disease, all these subtleties are not of interest. To successfully combat the manifestations of myocardial infarction, the stages of development of this process should be distinguished:

        Potential problems with myocardial infarction often depend on the course of the disease. More than 100 years ago, these three forms of myocardial infarction were described by the famous Russian clinician V.P. Samples.

        The relevance of this classification for stopping the acute onset of MI is recognized by doctors today:

      • The anginal form of myocardial infarction manifests itself as severe pain. The pain is acute, begins in the heart area and radiates to the left shoulder and arm. The intensity of the attack can lead to a serious complication of this disease - cardiogenic shock.
      • If, with the development of necrosis of the heart muscle, the main symptoms are signs of respiratory failure and pulmonary edema, we can talk about the asthmatic form of the disease. In this case, there is no pain, and the severity of the patient’s condition is caused by a lack of oxygen in the body’s tissues.
      • In the abdominal form of heart disease, gastrointestinal disorders, epigastric pain, nausea and vomiting come to the fore. When carrying out differential diagnosis, this condition is often confused with intestinal infections, which leads to late initiation of drug therapy for myocardial infarction and various complications in the future.
      • Understanding that acute myocardial necrosis can occur with various symptoms should help in choosing the right tactics when providing first aid in stopping the initial stage of the disease.

        Basic actions of a nurse in the early stages of myocardial infarction

        An attack of myocardial infarction usually occurs suddenly and requires an emergency response to the situation. If at this moment there is a nurse next to the patient, then her actions should be aimed at limiting the area of ​​necrosis of the heart muscle and preventing possible complications with the further development of the disease.

        First of all, medical personnel or household members must ensure complete rest for the patient. To do this, he should be given a semi-sitting position, access to oxygen or fresh air should be provided, and the patient should be reassured. Before starting drug therapy, it is necessary to carry out the simplest studies: measure blood pressure, evaluate the frequency and filling of the pulse.

        Among the medications in these first minutes of illness, you can use nitroglycerin 5-10 mg or validol. The effect of nitroglycerin usually begins within 2 - 3 minutes; if there is no effect, the medication can be repeated. If relief does not occur within 10 minutes, then angina can be ruled out.

        Some experts recommend using cold compresses or mustard plasters on the heart area to relieve pain and reduce the area of ​​necrosis. Resuscitators do not recommend conducting such experiments on your own, since the risk in this case exceeds the expected result.

        Subsequently, treatment of myocardial infarction is carried out in the intensive care unit of the cardiology hospital. A completely successful treatment regimen for such patients has been developed; it includes pain relief, the prescription of sedatives, beta blockers and aspirin. Continuous oxygen inhalation is carried out through a mask or endotracheal tube.

        According to modern methods, thrombolytic therapy begins within 1 - 2 hours from the onset of the disease. The use of alteplase, streptokinase and various heparins improve the patency of the coronary vessels and reduce the area of ​​necrosis of the heart wall.

        The work of a nurse in an intensive care unit is very important; she is responsible for the timely implementation of all medical prescriptions and constant care for the patient.

        Help from a nurse during the recovery period after myocardial infarction

        With each day of hospital stay the patient's condition improves, his physical activity increases. If the course of the disease is favorable, during the first 2 to 5 days the patient increases the range of his movements in bed, performs various gymnastic exercises, and sits down.

        Days 6–10 of hospital stay are usually devoted to restoring walking skills, movement within the ward is allowed, and from day 11 you can move along the corridor. Usually the patient is in a hospital for up to 4 - 5 weeks, while his physical activity is constantly increasing.

        The main role in everyday rehabilitation activities after myocardial infarction is played by nursing staff. Nurses accompany patients during walks, help them learn and carry out exercise therapy complexes, and conduct regular monitoring of their condition after physical activity.

        They are entrusted with:

        • fulfillment of all medical prescriptions;
        • caring for seriously ill patients;
        • control of vital functions of people who have suffered a myocardial infarction.
        • Nursing staff also plays an important role in a sanatorium. They perform the main functions of monitoring vacationers and carrying out various rehabilitation procedures. After a myocardial infarction, various complications from the cardiovascular system are possible. The nurse should be the first to identify any pathology in the patient and notify the attending physician.

          The role of nursing staff in the treatment of myocardial infarction and the rehabilitation period after this disease cannot be overestimated. It is to nurses that many patients owe their health, early return to active life, and even life itself.

          Treatment of myocardial infarction in a hospital is a set of measures aimed at saving the patient’s life. The outcome of the disease depends on the work of doctors.

          Recognizing myocardial infarction on an ECG can be difficult due to the fact that different stages have different signs and variations of waveforms. For example, the acute and acute stage may not be noticeable in the first hours. Localization also has its own characteristics: the infarction on the ECG is transmural, q, anterior, posterior, transferred, large-focal, lateral, different.

          Myocardial infarction, the symptoms of which in men cannot be immediately attributed to this disease, is very insidious. That is why it is important to have time to provide first aid.

          The causes of small-focal myocardial infarction are similar to all other types. It is quite difficult to diagnose; acute on ECG has an atypical picture. The consequences of timely treatment and rehabilitation are much easier than with a regular heart attack.

          Nutrition after myocardial infarction is quite limited. Moreover, the menu differs even depending on the gender of the patient. What can you eat?

          Transmural infarction is often detected on an ECG. The causes of acute, anterior, inferior, posterior wall of the myocardium lie in risk factors. Treatment must be started immediately, because the later it is provided, the worse the prognosis.

          Under the influence of external factors, a pre-infarction state may occur. The signs are similar in women and men; recognizing them can be difficult due to the location of the pain. How to relieve an attack, how long does it last? At the appointment, the doctor will examine the ECG readings, prescribe treatment, and also tell you about the consequences.

          Depending on the time of onset, as well as the complexity, the following complications of myocardial infarction are distinguished: early, late, acute, frequent. Their treatment is not easy. To avoid them, preventing complications will help.

          Symptoms and signs of pancreas problems with pancreatitis

          The pancreas is one of the most important glands in the human body. Often, the least attention is paid to its condition, even despite the enormous influence of this gland on a person’s life.

          The first symptoms that indicate problems with the pancreas:

        • heaviness in the upper abdomen;
        • digestive disorders;
        • increased gas formation;
        • sticky or loose stools.
        • Problems with the pancreas most often appear suddenly, for the time being, without disturbing the person. The average age of patients is 30-45 years. During these years, people are actively building their careers, are passionate about family, home, which is why they do not notice the first signs of organ pathology.

          Among the diseases of the pancreas, the following are especially distinguished: pancreatitis, diabetes mellitus, stones, etc.

          Pancreatitis is an inflammation of the pancreas lining. The tissues are irritated by enzymes that cannot find their way into the duodenum due to its blockage with protein plugs. As a result, the organ becomes inflamed and cannot fully produce the enzymes necessary for successful digestion.

          Acute pancreatitis is accompanied by sharp, unbearable pain. The attacks are aggravated by nausea and vomiting. The general condition of the human body in this case is sharply unsatisfactory and requires immediate professional medical care.

          Chronic pancreatitis develops gradually and for some time manifests itself very weakly or does not manifest itself at all. The pain is not so severe, but swelling and hemorrhage may occur. If the inflammation is not stopped, the gland cells will begin to die, and pancreatic necrosis occurs. Signs of this disease are high body temperature and intense pain. This disease is deadly and requires immediate medical treatment.

          Diabetes mellitus can be caused by a variety of reasons. It can be type 1 and occur due to low insulin production, or it can develop as a result of pancreatitis during menopause. Symptoms of diabetes are thirst, frequent trips to the toilet, weight loss, weakness, numbness of the limbs.

          Stone formation is also a common problem. The exact reasons for the formation of stones are still not known. But among the probable ones are disorders in the gastrointestinal tract, bad habits, metabolic disorders, and hormonal disorders. Symptoms of pancreatic stones vary and depend on the location of the stones. This may include pain in the upper abdomen, pain radiating to the lower back, as well as jaundice.

          Potential and actual patient problems with pancreatitis

          During an attack of acute pancreatitis, the patient experiences girdling pain in the abdomen, left hypochondrium or pit of the stomach. Poor treatment can lead to real problems and the disease becoming chronic. This form of the disease is characterized by nausea, vomiting, diarrhea, belching, and flatulence. Chronic pancreatitis can provoke the development of infectious inflammation in the pancreas, the appearance of erosions, ulcers and bleeding of the digestive system. Advanced chronic pancreatitis leads to such dangerous and irreversible potential problems as necrosis, lipomatosis, fibrolipomatosis. The long course of the chronic form of the disease affects endocrine function and leads to a decrease in insulin production. Lack of insulin in the body leads to the development of diabetes.

          Treatment of pancreas problems

          The method of getting rid of problems with the pancreas depends on the stage of the disease. During the period of exacerbation, the patient is indicated for hospitalization. Three main components of treatment: hunger, cold and rest. In the first two to three days, any food is contraindicated. It is allowed to drink only alkaline mineral water without carbon or herbal teas. Bed rest is mandatory. To reduce pain, apply a heating pad with ice to the pancreas area. To relieve spasms, take No-shpa or papaverine. During the period of remission, treatment consists of following a gentle diet, taking anti-inflammatory and painkillers, and taking pancreatic enzymes.

          Diet for problems with the pancreas

          If diseases of the pancreas are detected, a therapeutic diet must be followed throughout life (table No. 5). During the period of remission, the basic principles of nutrition are moderation and frequency. For problems with the pancreas, five meals a day is optimal. Also, special attention should be paid to portion size and food temperature. Portions should be small and food temperature should be between 30°C and 50°C. The patient's diet should consist of protein foods. Processed vegetables and soups with vegetable broths, cereals in the form of flakes, lean meat, lean fish, and cottage cheese with minimal fat content are welcome. Drinking plenty of fluids is a must. In case of pancreatitis, fatty, spicy, fried, canned and smoked foods, as well as alcohol, carbonated drinks, rye bread, ice cream, herbs, and spices should be excluded from the diet. It is prohibited to consume certain vegetables raw (cabbage, sorrel, radish/radishes, onions).

          Remember, in order to prevent problems with the pancreas, you need to lead a correct lifestyle, do not abuse excessively fatty and spicy foods, and eliminate bad habits. If the body already has problems in the functioning of the gastrointestinal tract, it is necessary to carry out preventive examinations as often as possible.

          If the disease cannot be avoided, then at the first symptoms you should immediately consult a doctor.

          Categories : Treatment methods

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