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How MI leads to Oliguria

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Paige Jauregui

on 23 November 2014

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Transcript of How MI leads to Oliguria

How MI leads to Oliguria
Audrey Dahlberg and Paige Jauregui
Nursing Diagnosis
Fluid volume excess
related to retention of sodium and water AEB decreased urinary output less then 0.5mL/Kg/Hour secondary to myocardial ischemia.
Decreased cardiac output
related to myocardial infarction AEB increased serum C-reactive protein and serum glycogen phosphorylase isoenzyme (GPBB).
Spiritual distress
related to suffering secondary to myocardial infarction AEB patient questioning beliefs.
Clinical Manifestations
Fluid Volume excess
o Jugular vein distention
o Increased blood pressure
o EKG changes (change in electrolytes)
Decreased cardiac output
o Decreased LOC
o Oliguria
o Rapid breathing
Spiritual Distress
o Disconnect with family
o Depression
o Decline in meaning of life
Cellular leading to tissue level
Tissue
Organ
Patient Education
Overview
One of the most significant causes of death is myocardial infarction also known as a heart attack and 720,000 Americans have one each year. (CDC, 2014)
The main cause is atherosclerotic plaque in the coronary arteries that ruptures and forms a thrombus that leads to a myocardial infarction.

Oxygen and nutrients are delivered to the cardiac cells (also known as myocardial cells) from the Coronary artery.
These myocardial cells use oxygen and nutrients like glucose to complete the crossbridge cycle (Completes contraction).
References
The crossbridge cycle is when the sarcomere (contraction unit) that is made of actin and myosin work together to shorten.
When there is a lack of blood supply to the myocardium, ATP is depleted and the metabolic demands are not meet.
After 8 to 10 seconds of decreased blood flow, the myocardium becomes cyanotic.
Hydrogen ions
and lactic acid accumulates as anaerobic glycolysis occurs.
The low pH damages the myocardium. Contraction and conduction of the cells are disrupted.
Decreased delivery
of potassium, Calcium and magnesium diminish the pumping ability of the myocardium.
Due to the fact that there is less NA/K pumping ability, intracellular Na and Ca (with water following) accumulate and K rapidly leaves the cell. This all totals to cellular swelling.
Catecholamines are released from the heart, which mediate the release of glycogen, glucose and fat (energy stores) from the body.
Norepinepherine (catecholamine) increases blood glucose levels and suppresses pancreatic beta cell activity, which decreases serum insulin levels=Elevated serum glucose.
Angiotensin 2 then stimulates the release of
ADH from the posterior pituitary that increases water retention in the kidney and vasoconstriction in vasculature.
The decreased cardiac output leads to poor perfusion, especially in the kidneys. Renin is released from the juxtaglomerular cells which travel through the blood and react with angiotensinogen to create Angiotensin 1, this reacts with ACE (from the lungs) to form Angiotensin 2.

Aldosterone from the adrenal cortex which causes reabsorption of NA / CL and water and excretion of K. And further vasoconstriction.
The overall effect is vasoconstriction, fluid retention, which increases myocardial work. Also leads to remodeling of the myocardial
Cell Analogy
Tissue Analogy
WATER PIPE
Kidney
Poor kidney perfusion causes intracellular vasoconstriction leading to intra-renal failure.
The decrease in GFR increases the RAAS system and decreases urine output leading to Oliguria.
Heart
The vasoconstriction of blood vessels leads to increased after load and increase MAP and BP of the heart. There is also an increased blood volume due to the kidneys reabsorbing water.
After 20 minutes there is a lack of response to the electrical impulses this leads to a failure of heart contractility and impaired cardiac output leading to death.

Organ Analogy
Normal heart pumping ability requires consistent blood delivery of oxygen and nutrients like glucose. One of the most significant causes of death is myocardial infarction (MI) also known as a heart attack. The main cause is atherosclerotic plaque in the coronary arteries that ruptures and forms a thrombus (clot) that leads to a myocardial infarction. 2(book). During an MI the blood flow to the kidneys decreases and the body attempts to fix it. It does this through retaining water and electrolytes in hopes to enhance blood flow to vital organs. After 20 minutes of using alternative energy sources, the heart starts to fail and leads to multiple organ failure and death.
Water pipe goes into the house and supplies the parts of the water softener with water. In this analogy, the pipe is the coronary artery bringing oxygen and nutrients like glucose to the myocardial cells which are parts of the water softener.
Tissue
Cell
Tissue
After 8 to 10 seconds of decreased blood flow, the myocardium becomes cyanotic.
The low pH damages the myocardium. Contraction and conduction of the cells are disrupted.
Necrosis of the myocardial tissue start and the contractility declines.
The water softener (myocardial tissue) is what that delivers water (blood) to the entire house (body).
The water softener supplies the appliances with water to make the organs work. In this analogy the appliances are the organs and the water is blood.
If the pipe supplying the water softener is frozen, the water softener delivers less and less water to the appliances until there it stops working. This can be the same as the body because during a heart attack, there is decreased perfusion to the heart, decreased cardiac output and perfusion to the organs.
Basics
Signs and Symptoms
You may experience angina, which is chest pain that occurs when an individual has coronary artery disease. Heart Attack pain is more severe and not alleviated with rest. Common signs of a heart attack are shortness of breath, nausea, light headedness, cold seats and back, shoulder, chest, neck, arm or joint pain.
Risk and Future Ramifications
Risk factors:
Obesity, HTN, smoking, high cholesterol, lack of exercise, poor diet, skipping medication, uncontrolled pathologies, previous heart attack, stress and anger.

Future Ramifications:
Drugs may be given to break down the clot (blockage).
Surgeries (When drugs are not effective enough):
• Angioplasty (Stent), which is a mesh tube that keeps the artery open.
• Bypass surgery (rerouting) is when a small section of vein or artery from other part of the body, is placed in the heart to “reroute” blood flow around the blocked artery. This ensures proper heart muscle blood supply.

1.) Take prescribed medications: Decreases blood pressure, clots, cholesterol and regulate diabetes.
2.) Exercise frequently: Strengthens heart.
3.) Weight reduction: Reduces work of the heart.
4.) Quit smoking: Smoking raises blood pressure, decreases oxygen, increases heart rate, damages blood vessels and increases clot risks.
5.) Healthy Diet: Low sodium, fat and cholesterol. Also, consume heart healthy foods.
6.) Control Stress and Anger: reduces blood pressure.
6 considerations
TO FIX this the decreased perfusion, the kidney increases blood volume by decreasing urine output. This is the same as not flushing the toilet (kidney) water and using the water from the toilets for the water softener. The overall retention of water and electrolytes supplies the vital organs, and in the analogy, the vital organ is the water softener. After 20 minutes of using alternative sources, the heart fails leading to multiple organ failure.
Brill, J. (2011). Heal your heart with food: 8 FOODS THAT HELP PREVENT A SECOND HEART ATTACK. Better Nutrition, 73(2), 38-42.

Chen, M. (2013, May 1). Heart attack. Retrieved November 1, 2014, from http://www.nlm.nih.gov/medlineplus/ency/article/000195.htm

Heart Disease Fact Sheet. (2014, August 20). Retrieved November 1, 2014, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm

Huether, S. E., & McCance, K. L. (Eds.). (2012). Understanding Pathophysiology (5th ed.). St. Louis, Missouri: Elsevier Mosby.

Who Is at Risk for a Heart Attack? (2013, December 17). Retrieved November 2, 2014, from http://www.nhlbi.nih.gov/health/health- topics/topics/heartattack/risks.html

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