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Lewis textbook of medical surgical nursing pdf

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Fundamentals of medical-surgical nursing: a systems approach / edited by . and the realisation that a comprehensive textbook on medical and surgical nursing Lewis, S.J., & Heaton, K.W. () Stool form scale as a useful guide to Retrieved 7th March from soundofheaven.info physician_gls/pdf/. Note - Table of Contents does not have page reference numbers. This isNOT a PHYSICAL BOOK. This is aPDF FILE. | eBay!. pdfsdocuments2 - lewis med surg test bank soundofheaven.info free download here for brunner & suddarth's textbook of medical- surgical nursing, 12th edition, is a.


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medical–surgical nursing Lewis's Assessment and Management of Clinical Problems . More than a textbook, this is a care and nursing management of various. Medical-Surgical Nursing 10th Edition by Brunner & Suddarth Handbook for Brunner and Suddarth's Textbook of Medical-Surgical Nursing. medical–surgical nursing. Lewis's. Assessment and Management of Clinical .. the book. • videos and animations. • answer guidelines for case study clinical.

He may decide that he can live with a weight reduction cardiac catheterisation before discharge. Back to home page Return to top. Consequently, a diminished blood poorly understood. Tell the patient the to know, several types of information are essential in achieving maximum HR that should be present at any point. Statins and hsCRP test refine cardio care, You explain that pl to take his vital signs and notice a worrying trend. Twenty years done differently?

Tanner18 provides a You commence your shift and check his charts. He currently has a succinct summary of the relationship between clinical judgement vital signs chart and a patient-controlled analgesia PCA chart. Thinking like a nurse 29 His vital signs at are: His pain levels have not been recorded. He also has a medication chart, but you remember that he has been self-administering his bronchodilator.

You note that the Establish goals doctor needs to see Les Green when he gets to the hospital to What are the most important short-term goals to achieve?

However, he has great difficulty in moving, and ra when you ask him if he wants to go to the toilet before his shower Evaluate he declines. While you assist him to shower, you notice there is You continue to monitor Les Green for the rest of the shift and quite a lot of bruising around his rib cage.

After you have dried him notice that by he is starting to look a little less pale and has urinated mL. You let him sit for a few minutes. After dressing him, you assist him into a wheelchair to go back to bed. He sleeps for the rest of the morning.

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Reflection and review Au 1. What have you learned from this case study?

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Process the information 2. At his deterioration? What do you think is going on here? What physiological reasons might account for these vital signs? Identify the problem After processing the information you have collected and talking to Les Green further, you find that he is in pain. A colleague asks you to describe clinical reasoning. How do you respond? Clinical reasoning is that his pain level is eight on a visual analogue scale. What are the most important short-term goals for Les Green b.

Take action c. Make a list of nursing actions you would take and explain the d. You ring the doctor, who tells you to give Les Green his 2. Critical thinking in clinical practice is an important skill fs pain relief and see if this will settle him.

He tells you that his pain score has c. Your hospital wants to introduce a MET. You are asked to e Consider the patient situation Les Green continues to doze in bed. You wake him at hours outline the rationale for this to other staff on your ward. You explain that pl to take his vital signs and notice a worrying trend. His pulse and respiratory rates have increased and his blood pressure is slightly a.

Collect cues c. What other cues could you collect to assist you in identifying any d. The advantages of using early warning systems for clinical Continue to evaluate observations include select all that apply You decide to complete a physical assessment of Les Green.

The nurse explains to the patient that she or he will take done so since then. The patient asks how this differs from what the doctor does. Describe the aetiology and pathophysiology of coronary artery disease, angina and acute coronary syndrome ACS , p acute coronary syndrome.

Identify risk factors for coronary artery disease and the nursing role in the promotion atherosclerosis, p Au of therapeutic lifestyle changes in patients at risk.

Compare and contrast the precipitating factors, signs and symptoms, collateral circulation, p multidisciplinary care and nursing management of the patient with coronary artery coronary artery disease CAD , p disease and chronic stable angina.

Describe the signs and symptoms, complications, diagnostic study results and metabolic equivalent MET , p er multidisciplinary care of the patient with acute coronary syndrome. Describe the pathophysiology of myocardial infarction from the onset of injury to PCI , p the healing process. Identify commonly used drug therapy in treating patients with coronary artery silent ischaemia, p disease and acute coronary syndrome.

Cardiovascular disease, which incorporates ischaemic heart symptoms of CAD and are termed acute coronary syndrome disease and other vascular conditions, is the major cause of ACS. Coronary artery disease that nearly , Australians have CAD;1 and in New fs CAD , or ischaemic heart disease, is the most common type Zealand, each day approximately 15 people die as the result of cardiovascular disease.

Patients with CAD can abnormalities, smoking, hypertension, diabetes mellitus, pr be asymptomatic or develop chronic stable angina. Unstable abdominal obesity, psychosocial factors, physical inactivity, angina UA and myocardial infarction MI are more serious and inadequate intake of fruits and vegetables. A, Total cardiovascular diseases.

B, Cancer. C, Respiratory disease. D, Accidents and poisoning. E, All other. The term atherosclerosis comes from two Greek words: This Au combination implies that atherosclerosis begins as soft deposits of fat that harden with age.

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It is characterised by deposits of lipids within the intima of the artery. The endothelium the inner lining of the vessel wall is normally non-reactive to platelets and leukocytes, as ' well as coagulation, fibrinolytic and complement factors. B, Fatty streak and lipid core formation. Raised plaques are visible: D, Complicated lesion: Plaque is C-reactive protein CRP , a protein produced by the liver, complicated by red thrombus deposition.

Chronic elevations of CRP are The fibrous plaque stage is the beginning of progressive changes associated with unstable plaques and the oxidation of low- in the endothelium of the arterial wall. These changes can density lipoprotein LDL cholesterol. Developmental stages Normally the endothelium repairs itself immediately pl except in the person with CAD. Once endothelial injury has taken place, well advanced.

The stages of development in atherosclerosis are: Collagen sa covers the fatty streak and forms a fibrous plaque with a greyish Fatty streak or whitish appearance. As streaks The borders can be smooth or irregular with rough, jagged of fat develop within the smooth muscle cells, a yellow tinge edges.

Yet, atherosclerotic plaque has been found in fetuses and infants, particularly where the mother smoked. Modifiable risk factors include elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychological states depression and anxiety and elevated homocysteine level. Data on risk factors for CAD come from several major studies.

In the Framingham study one of the first and most widely known , men and women were observed for 20 years. Over time, it was noted that elevated serum cholesterol greater lia A B C than 6. C, Total coronary artery occlusion with collateral circulation bypassing the occlusion to supply Age, gender and ethnicity blood to the myocardium. The thrombus may adhere to the wall er at rates higher than their non-Indigenous counterparts. Activation of the exposed platelets causes expression disease and diabetes risk assessment.

This, in vi Heart disease kills almost 10 times more women than breast turn, leads to further platelet aggregation and adhesion, further cancer. Even though cardiovascular disease remains the leading enlarging the thrombus. At this stage the plaque is referred to as a complicated lesion Fig , D. Women tend to manifest CAD collateral circulation, exist within the coronary circulation.

This is thought to be related to Two factors contribute to the growth and extent of collateral the loss of the cardio-protective effects of natural oestrogen circulation: Most women have symptoms of vessels angiogenesis and 2 the presence of chronic ischaemia.

When occlusion of Genetic link the coronary arteries occurs slowly over a long period, there is Genetic predisposition is an important factor in the occurrence a greater chance of adequate collateral circulation developing, oo of CAD. Most and the myocardium may still receive an adequate amount of times, patients with angina or MI can name a parent or sibling blood and oxygen. However, with rapid-onset CAD e. Consequently, a diminished blood poorly understood.

It is estimated that the genetic contribution flow results in a more severe ischaemia or infarction. This proportion relates CAD develops over many years, and signs and symptoms mainly to genes that control known risk factors e.

Therefore, e metabolism. Risk factors in different lipids are presented in Figure The risk of CAD is associated populations may vary. For example, major risk factors for CAD with a serum cholesterol level of more than 5.

See and hypertension, are more prevalent in Indigenous Australians, Table for normal serum lipid values. Lipids Many risk factors have been associated with CAD and are combine with proteins to form lipoproteins.

Lipoproteins categorised as non-modifiable and modifiable Table HDL ratio Total cholesterol: HDL ratio El Risk level men No diabetes Diabetes Non-smoker Smoker Non-smoker Smoker Age fs 65—74 oo Systolic blood pressure mmHg Systolic blood pressure mmHg pr Age 55—64 e pl Age 45—54 m sa Age 35—44 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 Total cholesterol: New Zealand Guidelines Group, Figure Australian cardiovascular risk assessment levels.

Heart Foundation, See Fig , which illustrates the types of dietary fat. Non-modifiable risk factors Modifiable risk factors HDLs contain more protein by weight and fewer lipids than Age Major any other lipoprotein.

Several types of ra Genetic predisposition and Physical inactivity apolipoproteins exist e. Women family history of heart disease Obesity: Physical activity, Kidney function: Homocysteine levels VLDLs contain both cholesterol and triglycerides, and may vi Evidence of atrial fibrillation deposit cholesterol directly on the walls of arteries. HDL, high-density lipoprotein; LDL, low-density lipoprotein genetic disorders have been associated with elevated triglyceride Source: Lifestyle factors that can contribute to elevated ; Australian National Vascular Disease Prevention Alliance, Available from www.

Guidelines for the assessment of absolute cardiovascular disease risk, Incidence st acutely ill from CAD e. Genetic testing men than women.

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After age 65, the incidence of MI in men and women equalises. EP studies is more MI, women are more likely to pr predictive in men. People with insulin resistance often target BP goals. The stress of an elevated BP increases the rate of The current national guidelines for treating elevated LDL atherosclerotic development. Risk causes narrowed, thickened arterial walls and decreases the scores are calculated based on information about the follow- distensibility and elasticity of vessels.

More force is required to ing: This increased workload results in fs cholesterol level. Excessive salt intake positively correlates with oo and the LDL goal is less than 4. People at very elevated BP, adding volume and increasing systemic vascular high risk have CAD and multiple risk factors. See Ch 29 for a for these patients is less than 1. Risk profiles are outlined in Figures and Tobacco use A third major risk factor in CAD is tobacco use. Further, tobacco smoking decreases oestrogen levels, pl mmHg if the patient has diabetes or chronic kidney disease placing premenopausal women at greater risk for CAD.

Risk is or current use of antihypertensive medication. Changing to m increases the risk of death from CAD fold in all people. In postmenopausal women, hypertension is associated with Nicotine in tobacco smoke causes catecholamine i.

These neurohormones sa women. Hypertension is graded 1—3. See workload. Tobacco smoke is also related to an increase in Table , which outlines classification of the different LDL level, a decrease in HDL level, and release of toxic oxygen levels. All of these add to vessel inflammation and thrombosis. Carbon monoxide, a by-product of combustion found Therapeutic lifestyle changes should begin in people at risk in tobacco smoke, affects the oxygen-carrying capacity of of hypertension.

Those with stage 1 or 2 hypertension often haemoglobin by reducing the sites available for oxygen require more than one drug to reach therapeutic goals9 see transport. Thus the effects of an increased cardiac workload, Ch 29 and Table TABLE Reducing risk factors for coronary artery There is also some indication that carbon monoxide is a chemical disease irritant and causes injury to the endothelium.

CAD mortality rates drop to those of non-smokers coronary artery disease, include the following information. However, nicotine is highly addictive, and Risk factor Health-promoting behaviours often intensive intervention is required to assist people to quit. Avoid exposure to Chronic exposure to environmental tobacco second-hand smoke also increases the risk of CAD.

CAD similar to those exposed to environmental tobacco smoke. Physical inactivity is the fourth major modifiable risk factor.

An example of health-promoting regular and vegetable proteins in diet. Physically active people have increased HDL levels. For those individuals with CAD, regular state harmful to health. Obesity is defined as a body mass index BMI of greater angry, anxious, etc. Obesity is often associated with hypertension.

Consider smaller, more figure have a higher incidence of CAD see Table As frequent meals. Perfusion blood glucose levels, than the general population. The patient Homocysteine with diabetes manifests CAD not only more frequently but also High blood levels of homocysteine have been linked to an at an earlier age. Homocysteine is produced by the breakdown of the essential Diabetes virtually eliminates the lower incidence of CAD in amino acid methionine, which is found in dietary protein.

High premenopausal women. Undiagnosed diabetes is frequently discovered at the time 1 damaging the inner lining of blood vessels, 2 promoting a person has an MI. The person with diabetes has an increased plaque build-up, and 3 altering the clotting mechanism to lia tendency towards endothelial dysfunction. This may account make clots more likely to occur see Table Diabetic Research is ongoing to determine whether a decline in patients also have alterations in lipid metabolism and tend to homocysteine can reduce the risk of heart disease.

B-complex ra have high cholesterol and triglyceride levels. Management of vitamins B 6, B 12, folic acid have been shown to lower diabetes should include lifestyle changes and drug therapy to blood levels of homocysteine. Au Metabolic syndrome refers to a cluster of risk factors for CAD whose underlying pathophysiology may be related Substance abuse to insulin resistance.

These risk factors include obesity as The use of illicit drugs, such as cocaine and methampheta- defined by increased waist circumference, hypertension, mine, can produce coronary spasm resulting in myocardial er abnormal serum lipids and an elevated fasting blood glucose ischaemia and chest pain. Most people who are seen in the ED see Table Chapter 37 from those with CAD. Although MI can occur, these patients vi discusses metabolic syndrome.

However, Health promotion the study of these behaviours remains controversial and The appropriate management of risk factors in CAD may complex. One type of behaviour, referred to as type A, includes prevent, modify or slow the progression of the disease.

Over the perfectionism and a hardworking, driven personality. The type A past 30 years, there has been a gradual and persistent decline in person often suppresses anger and hostility, has a sense of time cardiovascular-related deaths. This person efforts to become generally healthier, as well as advances may be more prone to MIs than a type B person, who is more in drugs and technology to treat CAD.

Prevention and early easy going, takes upsets in stride, knows personal limitations, treatment of heart disease must involve a multifaceted approach fs takes time to relax, and is not an overachiever. However, findings and needs to be ongoing throughout the life span. These include Signs and symptoms of CAD are not apparent in the early depression, acute and chronic stress e.

Therefore, regardless of the healthcare setting, it is extremely important to identify people at risk for pr as a carer , anxiety, hostility and anger, and lack of social support. Risk screening involves obtaining a thorough health the development and worsening of CAD. Depressed patients history. Question the patient about a family history of heart have elevated levels of circulating catecholamines that may disease in parents and siblings.

Note the presence of any e contribute to endothelial injury and inflammation and platelet cardiovascular symptoms. Assess environmental factors, such activation. Higher levels of depression are also associated as eating habits, type of diet and level of exercise, to elicit pl with an increased number of adverse cardiac events.

Include a psychosocial history to determine research on the treatment of depression and other negative tobacco use, alcohol ingestion, recent stressful events e. The place and type of employment provide physical health.

SNS stimulation and illness. This information can give some indication of how causes an increased release of catecholamines i. This stimulation increases HR and intensifies reveal possible misconceptions about heart disease. Also, stress-induced mechanisms level needed for teaching.

If the patient is taking medications, can cause elevated lipid and glucose levels and changes in blood it is important to know the names and dosages and if the patient coagulation, which can lead to increased atherogenesis. Family history of heart abnormalities on ECG; cardiac enlargement, calcifications, or disease; sedentary lifestyle; tobacco use; exposure to environmental pulmonary congestion on chest X-ray; abnormal wall motion with Au smoke stress echocardiogram; positive coronary angiography Nutritional—metabolic: Indigestion, heartburn, nausea, belching, vomiting Elimination: Urinary urgency or frequency, straining at stool Activity—exercise: Palpitations, dyspnoea, dizziness, weakness er Cognitive—perceptual: Substernal chest pain or pressure squeezing, constricting, aching, sharp, tingling , possible radiation to jaw, neck, shoulders, back or arms see Table vi Coping—stress tolerance: El ness of the interventions see Table It is important to use important in controlling angina because excess weight increases the same words that patients use to describe their pain.

Some myocardial workload. Assess for other symptoms of pain, Adhering to a regular, individualised program of physical such as: Supportive and important. NTG may be used prophylactically Reassure the patient with a history of angina that a long, active before an emotionally stressful situation, sexual intercourse or oo life is possible.

Prevention of angina is preferable to its treat- physical exertion e. Provide the patient Patients feel a threat to their identity and self-esteem and with information regarding CAD, angina, precipitating factors may be unable to fill their usual roles in society.

These emotions for angina, risk factor reduction, and medications. If they persist or cause problems in a pr Patient teaching can be done in a variety of ways. Time spent providing daily care e.

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Nursing implementation: Acute coronary Teaching tools such as DVDs or CDs, heart models and printed syndrome pl information are important components of patient and carer Acute intervention teaching see Resources at the end of the chapter. Priorities for nursing interventions in the initial phase of ACS m Assist the patient to identify factors that precipitate angina include: Educate the patient about how to avoid or monitoring, 3 promotion of rest and comfort, 4 alleviation control precipitating factors.

Patients with increased of large, heavy meals. If a heavy meal is eaten, explain to the anxiety levels have a greater risk for adverse outcomes such patient that it is best to rest for 1 to 2 hours after the meal as recurrent ischaemic events and arrhythmias. In addition, institute measures to avoid the hazards of CAD. Then discuss the various methods of decreasing any immobility while encouraging rest. Teach the patient and carer about diets that are low in salt and saturated fats Pain Provide NTG, morphine and supplemental oxygen as see Tables and Maintaining ideal body weight is needed to eliminate or reduce chest pain.

Perfusion and documentation of the effectiveness of the interventions are BOX Phases of rehabilitation after coronary important. Once pain is relieved, you may have to deal with syndrome denial in a patient who interprets the absence of pain as an absence of cardiac disease. Phase I: Arrhythmias need to be progress to ambulation in hallway and limited stair climbing. In many patients, premature ventricular contractions or ra ventricular tachycardia precedes this arrhythmia. Monitor Phase II: If you note ST segment initiated at home.

Perform a physical assessment to detect deviations from the Phase III: In addition to routine vital implemented at home, a local gym or as an outpatient. If a nasal cannula is used to deliver oxygen, check the nares for irritation or dryness, which can cause considerable discomfort. El Rest and comfort It is important to promote rest and comfort with any degree of myocardial injury.

Bed rest may be ordered perceived control and independence. Examples include the for the first few days after an MI that involves a large portion of following: A patient with an uncomplicated MI e. Comfort measures that can promote rest begin once they are feeling stronger. Frequently the patient may include a quiet environment, use of relaxation techniques e.

Gradually experienced ACS. Denial may be a positive and assist the patient in reducing it. If the patient is afraid of coping style in the early phase of recovery from ACS. Help with the patient frequently. If a source of anxiety is fear of the to determine how you can help maximise the support system. For anxiety Often the patient is separated from the most significant support caused by lack of information, provide teaching based on the system at the time of hospitalisation.

For example, patients those who will provide the necessary support to the patient. Open visiting is helpful in decreasing anxiety and increasing The earliest questions usually relate to how the disease affects support for the patient with ACS. It is important for the health team to assist the ECG monitoring to detect arrhythmias, 5 an endotracheal patient to identify additional support systems e. Most patients are extubated within 6 hours and pl Coronary revascularisation transferred to a step-down unit within 24 hours for continued Patients with ACS may undergo coronary revascularisation with monitoring of cardiac status.

The major nursing responsibilities for Many of the postoperative complications that develop after patient care after PCI involve monitoring for signs of recurrent CABG surgery relate to the use of CPB.

Major consequences of angina; frequent assessment of vital signs, including HR and CPB are systemic inflammation, which includes complications sa rhythm; evaluation of the catheter insertion site for signs of of bleeding and anaemia from damage to red blood cells and bleeding; neurovascular assessment of the involved extremity; platelets; fluid and electrolyte imbalances; hypothermia as blood and maintenance of bed rest per institution policy.

For patients having CABG surgery, care is provided in Focus nursing care on assessing the patient for bleeding e.

Lewis textbook of medical surgical nursing pdf

The patient will have numerous invasive restoring temperature e. These include: Discharge is often delayed in these patients in order to Do exercise-based cardiac rehabilitation programs begin anticoagulation therapy. See Ch 32 for information on improve outcomes? Clinical question Nursing care for the patient with a CABG also involves In patients with coronary heart disease P , do exercise-based caring for the surgical sites e.

Care of the cardiac rehabilitation programs I versus usual care C reduce radial artery harvest site includes monitoring sensory and mortality and morbidity and improve quality of life O?

The patient with radial artery harvest should take a calcium channel blocker for approximately Best available evidence Systematic review of randomised controlled trials RCTs 3 months to decrease the incidence of arterial spasm at the ra arm or anastomosis site.

Management of the chest wound, angina pectoris, coronary artery bypass graft CABG or st which involves a sternotomy, is similar to that of other chest percutaneous transluminal coronary angioplasty PTCA. Other interventions include strategies to Exercise-based cardiac rehabilitation was exercise alone or with Au manage pain and prevent venous thromboembolism e.

Usual care included standard medical care and drug therapy with no structured ambulation, sequential compression device and respiratory exercise training. See Ch 16 for care of cardiovascular mortality, decreased hospital admissions and the postoperative patient. Patients Conclusion may cry or become teary.

In the older patient, elective CABG is generally well tolerated. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Pain management is important regardless of the procedure.

Syst Rev ;7: Ambulatory and home care pr Cardiac rehabilitation is the restoration of a person to an optimal state of function in six areas: Many learning needs helps them to set goals that are realistic. When patients and e psychological wellbeing.

All patients e. Answer the pl a cardiac rehabilitation program. The answers often the patient must recognise that CAD is a chronic disease. It require repetition. When the shock and disbelief accompanying m is not curable, nor will it disappear by itself. Therefore, basic a crisis subside, the patient and carer are better able to focus on changes in lifestyle must be made to promote recovery and new and more detailed information.

These changes often are needed at a time when Limit use of medical terminology. For example, explain sa a person is middle aged or older. The patient must realise that that the heart, a four-chambered pump, is a muscle that needs recovery takes time. Resumption of physical activity after ACS oxygen, like all other muscles, to work properly. When blood or CABG surgery is slow and gradual. However, with appropriate vessels supplying the heart muscle with oxygen are blocked by and adequate supportive care, recovery is more likely to occur.

As a result, the heart cannot pump normally. It helps to have a model of the Patient teaching Patient teaching needs to occur at every stage heart or to sketch a picture of what is being explained. ED, telemetry Anticipatory guidance involves preparing the patient unit, home care.

The purpose of teaching is to give the patient and carer for what to expect in the course of recovery and and carer the tools they need to make informed decisions about rehabilitation. By learning what to expect during treatment and their health. For teaching to be meaningful, the patient must be recovery, the patient gains a sense of control over his or her life. While you are syndrome, include the following information.

In addition, you describe a variety of smoking cessation interventions that he could choose. Your decision and action As his nurse, you respect and support his decision.

You ask his doctor for a prescription for the nicotine patch before he is discharged from se on maximal oxygen uptake, increasing CO, decreasing blood lipids, decreasing BP, increasing blood flow through the coronary arteries, increasing muscle mass and flexibility, El hospital. Nicotine therapy many years of sedentary living, is beneficial. A randomized clinical trial. Chronic disease management kilogram per minute. The MET determines the energy costs for tobacco dependence: A randomized, controlled trial.

Arch of various exercises Box In hospital, activity level is fs Intern Med ; Many oo patients with UA that has resolved or an uncomplicated MI are The idea of perceived control is operationalised as the process in hospital for approximately 3 or 4 days. By day 2, the patient by which the patient exercises choice and makes decisions can ambulate in the hallway and begin limited stair climbing pr by cutting back. Cutting back is one way of minimising the e.

Many cardiologists order low-level psychological and physiological losses after MI or any other exercise stress tests before discharge to assess readiness for life-changing event. For example, a middle-aged man who discharge, optimal HR for an exercise program, and potential smokes two packets of cigarettes a day, is 15 kg overweight, for ischaemia or reinfarction.

If tests are positive i. He may decide that he can live with a weight reduction cardiac catheterisation before discharge. If the test is negative, pl plan and will get more exercise although perhaps not daily a catheterisation may still be done before discharge or several but that it is not possible for him to quit smoking.

He reasons weeks after discharge. Because of the short hospital stay, it m that because he is modifying two of the three risk factors, he is critical to give the patient specific guidelines for physical will be healthier. Ideally, the tobacco risk factor should be a activity so that overexertion will not occur. It is important to priority for this patient. Teach patients to check their pulse rate.

The patient should In addition to teaching the patient and carer what they wish know the limits within which to exercise. Tell the patient the to know, several types of information are essential in achieving maximum HR that should be present at any point. If the HR optimal health. Box presents a teaching guide for the exceeds this level or does not return to the rate of the resting patient with ACS. Also instruct the patient to stop exercising and rest if chest pain Physical activity Physical activity, an integral part of reha- or shortness of breath occurs.

Activity should not be started or stopped abruptly. Breast stroke Freestyle Tennis 8 9 4 9 10 9 se Educate the patient to begin slowly at personal tolerance perhaps only 5—10 minutes and build up to 30 minutes. This point cannot oo Grocery shopping 2 4 be overstressed. Mowing by hand 5 7 The basic categories of physical activity are isometric static pr and isotonic dynamic. Isometric activities involve the development of tension Sexual intercourse 3 5 during muscular contraction but produce little or no change in Showering 3 4 muscle length or joint movement.

Lifting, carrying and pushing e heavy objects are isometric activities. Washing a car 6 7 Isotonic activities involve changes in muscle length and m joint movement with rhythmic contractions at relatively low Washing dishes 2 3 muscular tension. An individual exercising at 2 METs is isotonic.

Isotonic exercise can put a safe, steady load on the consuming oxygen at twice the resting rate. New Zealand Primary Care Handbook, Appendix D. Discuss participation in an outpatient cardiac rehabilitation Available from www.

These programs are beneficial, but not all patients choose or are able to participate in them e. Home-based cardiac rehabilitation programs can provide an alternative. Apr 08, Your country's customs office can offer more details, or visit eBay's page on international trade.

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