NUR302 Concepts In Nursing
Question:
Answer:
Pharmacological Management of myocardial infarction:
It demands emergency medical care which must begin with rapid identification of the diagnostic signs and symptoms. Pharmacological management depends on whether the myocardial infarction is STEMI or NSTEMI (O’Gara et al., 2013). First set of intervention is pain management, via the administration of nitro-glycerine. Anticoagulation therapy can be used with the help of anti-platelet anticoagulant and aspirin to reduce the size of the clot to reduce the blood clot. The pharmacological management of the condition generally depends on the fact that whether the myocardial infarction is STEMI or NSTEMI. In case of STEMI myocardial infarction, the help of percutaneous coronary intervention needs to be taken and in case this cannot be performed the intervention of choice is fibrinolysis (Dharmarajan et al., 2013). High flow oxygen therapy is given to all patients with myocardial infarction as well. This health care complication demands emergency medical care and the very first goal for the health care professional is rapid identification of the diagnostic signs and symptoms exhibited by the patient, so that the severity of the patient’s condition can be identified immediately and necessary care initiatives are taken.
Nursing implications:
The nursing implications for a nursing professional for caring for a patient going through myocardial infarction is firstly to ensure relieving the patient from the acute persistent pain. Secondly, emergency and immediate assistance to the patent and ensuring that the patient remains conscious until therapeutic measures are taken (Wald et al., 2013). Ensuring the patient is comfortable and relived during the treatment procedures and reperfusion therapy is commenced as fast as possible without any hassle. Diligent monitoring of the vital signs of the patient to ensure that the condition of the patient is improving rather than deteriorating (Swirski & Nahrendorf, 2013). Lastly risk assessment of the patient should also be completed for the complicated treatment options like the hazards of fibrinolysis and PCU therapy to ensure best interests of the patient.
Pharmacological management of gastric ulcers:
Gastric ulcer can be generally caused by the Helicobactor pylori infection in most cases. In case of patients that are penicillin intolerant the most probable therapeutic intervention has to be bismuth quadruple therapy. According to the Malfertheiner et al. (2012), the most effective and frequently reported and used therapeutic intervention in this case is this therapy and this therapy utilizes the bismuth, proton pump inhibitor (PPI), tetracycline, and a nitroimidazole. In case the patient is not responsive to this therapy, another most important pharmacological intervention can be the clarithromycin triple therapy, which utilizes the most important intervention combination of clarithromycin, a PPI, and amoxicillin or metronidazole.
Nursing implication:
The nursing interventions that can be used include avoiding the antibiotics that has been used previously by the patient. Along with that, care has to be taken by the nursing professional to stabilize the weight of the patient. The diet of the patient during the treatment for gastric ulcer should be bland low fiber food. Furthermore missing out on any meal time can exacerbate symptoms for this particular disease hence the nursing profession will also have to be very cautious about missing meal. Along with that, under the antibiotic treatment for gastric ulcer management patient should always avoid caffeinated beverages as it can stimulate the production of gastric juice leading to for the complications of the disease. Hence it also should be avoided under the watch of the nursing professional (Leontiadis et al., 2013).
Pharmacological treatment for inflammatory joint disease:
The pharmacological management and care plan for patients with rheumatoid arthritis or intimated joint disease consist of integral treatment approach which incorporates both pharmacological therapies. Elaborating on the pharmacological treatment for this disease administration of non steroidal anti inflammatory drugs are the most frequently opted treatment pathway for pain management . Along with that non biological biological disease-modifying antirheumatic drugs (DMARD) and immunosuppressants in combination with corticosteroids are also used to minimize the manifestation of the symptoms. It has been mentioned that the DMARDs has been rated as the most optimal standard of care for these patients, which is capable of not only retarding progression of the disease but can also induce remissions. In severe cases surgical intervention is also implement it including synovectomy, tenosynovectomy, tendon realignment, reconstructive surgery or arthroplasty, and even arthrodesis (Bombardier et al., 2012).
Nursing implications:
The nursing considerations for this disease include taking a very keen attention of any side effect of the NSAID or DMARD drugs. It has to be understood that depression can be easily induced by these treatments if prolonged, which needs to be contraindicated for this case. Along with that the administration of immune-suppressants can induce many new acquired infections which is needed to be taken care of. Along with that patients with this disease often require multidimensional care with support and individual expertise. Lastly, patients with inflammatory joint diseases, there is an enhanced risk of cardiovascular diseases and osteoporosis. Hence, the nursing professional must also consider preventing the onset of the above mentioned co-morbidities (Smolen et al., 2013).
References
Armstrong, P. W., Gershlick, A. H., Goldstein, P., Wilcox, R., Danays, T., Lambert, Y., … & Carvalho, A. C. (2013). Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. New England Journal of Medicine, 368(15), 1379-1387.
Bombardier, C., Hazlewood, G. S., Akhavan, P., Schieir, O., Dooley, A., Haraoui, B., … & Pencharz, J. (2012). Canadian Rheumatology Association recommendations for the pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs: part II safety. The Journal of rheumatology, 39(8), 1583-1602.
Bonaca, M. P., Bhatt, D. L., Cohen, M., Steg, P. G., Storey, R. F., Jensen, E. C., … & Bengtsson, O. (2015). Long-term use of ticagrelor in patients with prior myocardial infarction. New England Journal of Medicine, 372(19), 1791-1800.
Dharmarajan, K., Hsieh, A. F., Lin, Z., Bueno, H., Ross, J. S., Horwitz, L. I., … & Drye, E. E. (2013). Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Jama, 309(4), 355-363.
Leontiadis, G. I., Molloy-Bland, M., Moayyedi, P., & Howden, C. W. (2013). Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis. The American journal of gastroenterology, 108(3), 331.
Malfertheiner, P., Megraud, F., O’morain, C. A., Atherton, J., Axon, A. T., Bazzoli, F., … & El-Omar, E. M. (2012). Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut, 61(5), 646-664.
O’Gara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E., Chung, M. K., De Lemos, J. A., … & Granger, C. B. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 61(4), e78-e140.
Smolen, J. S., Landewé, R., Breedveld, F. C., Buch, M., Burmester, G., Dougados, M., … & Ramiro, S. (2013). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the rheumatic diseases, annrheumdis-2013.
Swirski, F. K., & Nahrendorf, M. (2013). Leukocyte behavior in atherosclerosis, myocardial infarction, and heart failure. Science, 339(6116), 161-166.
Wald, D. S., Morris, J. K., Wald, N. J., Chase, A. J., Edwards, R. J., Hughes, L. O., … & Oldroyd, K. G. (2013). Randomized trial of preventive angioplasty in myocardial infarction. New England Journal of Medicine, 369(12), 1115-1123.
Use the following coupon code :
SAVE10