Question

The nurse is caring for a patient who has a history of hypertension and is currently admitted to the hospital with a myocardial infarction. Discuss the pathophysiology of hypertension and it relationship to the MI, assessment information pertinent for the patient, lab work or diagnostic test appropriate for managing the disease process, pharmacology agent that would be appropriate for the patient, and specific nursing interventions addressing the specific needs and care measures. In the discussion discharge planning and teaching should be included.

Answer 1

Question: The nurse is caring for a patient who has a history of hypertension and is currently admitted to the hospital with myocardial infarction. Discuss the pathophysiology of hypertension and it relationship to the MI, assessment information pertinent for the patient, lab work or diagnostic test appropriate for managing the disease process, pharmacology agent that would be appropriate for the patient, and specific nursing intervention addressing the specific needs and care measures. In the discussion discharge planning and teaching should be included.

Increased renal oxidative stress 1 Na+ transport 1 Tubuloglomerular feedback sensitivity 1 Preglomerular resistance 1 Sodium reabsorption Glomerular filtration rate Renal pressure natriuresis Hypertension Source: Valentin Fuster, Robert A. Harrington, Jagat Narula, Zubin J. Eapen: Hurst's The Heart, Fourteenth Edition: www.accessmedicine.com Copyright © McGraw-Hill Education. All rights reserved.

Multifactorial and highly complex in the pathogenesis of critical hypertension. The kidney is both the leading and the target organ of the hypertensive processes, and the disorder requires multi-organ system activity and numerous independent or interdependent pathway mechanisms. Factors that play a significant role in hypertension pathogenesis include genetics, activation of neurohormonal systems such as the sympathetic nervous system and renin-angiotensin-aldosterone system, obesity, and increased consumption of dietary salt.

The additional stress and resultant harm from high blood pressure (HBP or hypertension) contribute to the gradual narrowing of the coronary arteries which support the heart from an accumulation of fat, cholesterol and other substances called plaque. Blood clots are more likely to form when arteries harden with plaque.

Diagnostic test:

1. Troponin level

2. Total creatinine kinase level

3. Ck-MB isoenzyme

4. WBC count

5. Electrocardiogram

6. Exercise tolerance test or stress test

7. Thallium scans

Pharmacological agent:

It interacts with beta-blockers, glyceryl trinitrate and probably ACE-inhibitors. Aspirin should be given to all patients with suspected myocardial infarction. It is an effective, fast-acting antiplatelet drug that reduces mortality by 20 percent. You will drink as soon as possible aspirin, 150-300 mg.

Nursing Intervention:

Acute myocardial infarction nursing care is intended to help the patient conquer multiple physical and psychological attacks. Therapeutic aims are designed to promote healing of the weakened myocardium, avoid complications, and facilitate the return of the patient to a normal lifestyle and health.

Assessment is one of the most important aspects of patient care with MI.

1. Assess with rest or treatment for chest pain not relieved.
2. Monitor vital signs of blood pressure and pulse rate in particular.
3. Assess for oxygen loss, dyspnea, tachypnea, and crackles.
4. Evaluate nausea and vomiting.
5. Assessment of reduced urinary production.
6. Evaluate the history of diseases.
7. To diagnose problems and adjustments in the condition of the patient, conduct a detailed and full physical examination.
8. Frequently test IV sites.

Discharge planning:

Identifying the expectations of the patient is the most successful way to increase the probability that the patient can develop a self-care regimen upon discharge.