General information

 Acute Myocardial Infarction (MI) introduction: Most myocardial infarctions are caused by a disruption in the vascular endothelium associated with an unstable atherosclerotic plaque that stimulates the formation of an intracoronary thrombus, which results in coronary artery blood flow occlusion. If such an occlusion persists for more than 20 minutes, irreversible myocardial cell damage and cell death will occur. The death of myocardial cells first occurs in the area of myocardium most distal to the arterial blood supply: the endocardium. As the duration of the occlusion increases, the area of myocardial cell death enlarges, extending from the endocardium to the myocardium and ultimately to the epicardium. The area of myocardial cell death then spreads laterally to areas of watershed or collateral perfusion. Generally, after a 6- to 8-hour period of coronary occlusion, most of the distal myocardium has died. The extent of myocardial cell death defines the magnitude of the MI. If blood f

 Gastroesophageal Reflux    Gastroesophageal reflux is the backward flow of gastric content into the esophagus.  GERD common, affecting 15 — 20% of adults  10% persons experience daily heartburn and indigestion.   Because  location near other organs symptoms may mimic other illnesses including heart problems. Etiology & Pathophysiology: Gastroesophageal reflux results from transient relaxation or incompetence of lower esophageal sphincter, sphincter, or increased pressure within stomach  Factors contributing to gastroesophageal reflux:  Increased gastric volume (post meals)Position pushing gastric contents close to   gastroesophageal junction (such as bending or lying down)  Increased gastric pressure (obesity or tight clothing) Hiatal hernia  Normally the peristalsis in esophagus and bicarbonate in salivary secretions neutralize any gastric juices (acidic) that contact the esophagus; during sleep and with gastroesophageal reflux esophageal mucosa is damaged and inflamed; prolonge

 Prevention *Prevention of viral infections may include: General measures Vaccines Immune globulins Vaccines and immune globulins help the body better defend itself against diseases caused by certain viruses (or bacteria). The process of strengthening the body's defenses is called immunization. First ⇛  General measures People can help prevent many viral infections by commonsense measures to protect themselves and others (personal protective measures). These measures vary depending on the how the virus is spread. Measures include the following:  Frequently and thoroughly washing the hands with soap and water for at least 15 seconds after contact with a person who has a viral disease, before eating, or after using the restroom or touching feces, body fluids, surfaces, or foods that are potentially contaminated with viruses Consuming only food and liquids that have been appropriately prepared or treated  Eating a well-balanced diet that includes sufficient amounts of fruits and veget

                          Liver cirrhosis   Cirrhosis is a late-stage liver disease in which healthy liver tissue is replaced with scar tissue and the liver is permanently damaged. The scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections Liver functions:  The liver is located in the upper right side of the abdomen below the ribs. It has many essential body functions. These include:  Producing bile, which helps your body absorb dietary fats, cholesterol, and vitamins A, D, E, and K  Storing sugar and vitamins for later use by the body  Purifying blood by removing toxins such as alcohol and bacteria from your system  Creating blood clotting proteins  Pathophysiology:  The liver is a very hardy organ and is normally able to regenerate damaged cells. Cirrhosis develops when the factors that damage the liver (such as alcohol and chronic viral infections) are present over a long period of time. When this happens, the liver becomes injured and sca

 Treatment of Intestinal Obstruction * There is two types of treatment :                                                                  👉        Nonsurgical Management                           👉            Surgery 1/ Nonsurgical Management: Correction of fluid and electrolyte imbalances with normal saline or Ringer's solution with potassium as required. NG suction to decompress bowel. TPN may be necessary to correct protein deficiency from chronic obstruction, paralytic ileus, or infection. Analgesics and sedatives, avoiding opiates due to GI motility inhibition. Antibiotics to prevent or treat infection. Ambulation for patients with paralytic ileus to encourage return of peristalsis. 2/ Surgery : *Consists of relieving obstruction. Options include : Closed bowel procedures: lysis of adhesions, reduction of volvulus, intussusception, or incarcerated hernia Enterotomy for removal of foreign bodies. Resection of bowel for obstructing lesions, or strangulated bowel with end to-en

 intestinal obstruction Definition : Intestinal obstruction occurs when the passage of intestinal contents through the lumen is impaired or it is an interruption in the normal flow of intestinal contents along the intestinal tract. Types (causes) of Intestinal Obstruction: 1. Mechanical obstruction. 2. Paralytic (adynamic, neurogenic) ileus. 3. Strangulation obstruction. 👉  Mechanical obstruction  An intraluminal obstruction or a physical block to passage of intestinal contents without disturbing blood supply of bowel.  High small-bowel (jejunal) or low small-bowel (ileal) obstruction occurs four times more frequently than colonic.       *Mechanical causes of intestinal obstruction: Adhesions from surgery, up to 70% of small bowel obstructions are caused by adhesions. Intussusception (telescoping of intestinal wall into itself)   volvulus (twisted loop of intestine).   Hernia    Tumor   Stenosis , stricture 👉  Paralytic (adynamic, neurogenic) ileus   Peristalsis is ineffective

Nursing management of peptic ulcer Assessment: The nurse asks the patient to describe the pain and strategies used to relieve it (e.g, food, antacids). The patient usually describes peptic ulcer pain as burning; it occurs about 2 hours after a meal and frequently awakens the patient between midnight and 3 am. o Taking antacids, eating, or vomiting often relieves pain. If the patient reports a recent history of vomiting, the nurse determines how often emesis has occurred and notes important characteristics of the vomits. o The nurse asks the patient about food habits. The nurse asks about lifestyle and other habits. Does the patient use irritating substances? Does he or she smoke cigarettes? If yes, how many/day? Does the patient ingest alcohol? If yes, how much and how often? Are NSAIDs used? The nurse inquires about the patient's level of anxiety. How does the patient express anger or cope with stressful situations? Is the patient experiencing occupational stress or problems withi

  Introduction Peptic Ulcer is a lesion in the lining (mucosa) of the digestive tract, typically in the stomach or duodenum, caused by the digestive action of pepsin and stomach   acid. Lesion may subsequently occur into the lamina and sub mucosa to cause bleeding. Most of peptic ulcer occurs either in the duodenum, or in the stomach. Ulcer may also occur in the lower esophagus due to reflexing of gastric content. Rarely in certain areas of the small intestine Definition:  Ulceration of mucosa which is exposed to acid peptic juice. Different sites can be affected duodenum, stomach, Jejunum edsophagus, and meckel’s diverticulum (contains ectopic gastric tissue)  Pathophysiology :   Under normal conditions, a physiologic balance exists between gastric acid secretion and gastro-duodenal mucosal defense. Mucosal injury and, thus, peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted. Aggressive factors, such as NSAIDs, H pylori infecti

                   Gestational diabetes First diagnosed during pregnancy and associated with an increase in adverse outcomes.   Resolves after delivery, may persist postpartum   increased risk of type 2 diabetes in later life.  Definition:  gestational diabetes occurs when your body can't make enough insulin during your pregnancy                                                                 or gestational diabetes is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth Causes of Gestational Diabetes: Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insuli

Rheumatic Fever  Acute rheumatic fever is a systemic disease of childhood, often recurrent that follows group A beta hemolytic streptococcal infection (GABH), usually develops within 3 weeks. It is a diffuse inflammatory disease of connective tissue, primarily involving heart, blood vessels, joints, subcutaneous tissue and CNS (Root-Bernstein, 2009).  Autoimmune consequence of group A beta hemolytic streptococcal infection following an upper respiratory infection. Cross reactive immunity between βhemolytic streptococcal group A to human cardiac tissue (WHO, 2011).  Rheumatic Heart Disease is the permanent heart valve damage resulting from one or more attacks of ARF.  It is thought that 40-60% of patients with ARF will go on to developing RHD.  The commonest valves affecting are the mitral and aortic, in that order. However all four valves can be affected  IN Egypt, 5-7% of cardiac surgery is due to rheumatic heart complications  If properly treated, 75% of people with rheumatic fever r

         Congestive HEART FAILURE (CHF)  Is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients Types of HEART FAILURE  : Systolic vs. diastolic  Left-sided vs. right-sided  Acute vs. chronic    Pathophysiology :  HF results from a variety of cardiovascular diseases but leads to some common heart abnormalities that result in decreased contraction (systole), decreased filling (diastole), or both.   HF results in depression of ventricular function and compensation take place by stretching of myocardial fiber.  This stretching leads to cardiac dilation which occur when left ventricle fail to eject its normal end diastolic volume.  Myocardial dysfunction most often occurs before the patient experiences signs and symptoms of HF.    Different causes of heart failure :  • CAD/Ischemic heart disease                        •  Cardiomyopathies  • Hypertension                                                •  Valvular heart disease