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ER Case study. 08802037 이수미. ☻목 차☻ 문헌고찰 간호사정 관련 논문 고찰 응급실 내원 중 환자의 간호 문제 간호 과정 적용 참고문헌. I. 문헌고찰. 심근경색 (Myocardial Infarction) 1. 정의 3 개의 관상동맥 중 어느 하나라도 혈전증이나 혈관의 빠른 수축 등에 의해 막히는 경우 , 심장의 전체 또는 일부분에 산소와 영양 공급이 급격하게 줄 어들어서 심장근육의 조직이나 세포가 죽는 ( 괴사 ) 상황 2 . 병태생리 - PowerPoint PPT Presentation

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ER Case study08802037

I. (Myocardial Infarction)

1. 3 , ()

2. ,,,,.70%() .I. 3. , 4. : , , , (15 ). , , , , , , , I. 5. 1) ST T ST Q 2) CK-MB : 8~24 Myoglobin : 2 Troponin : T 3~6 , I 7~14 LDH : 24~48 SGOT, SGPT : (10,000~20,000/mm3) : I. 6. 1) 2) : Morphine, Demerol3) : ()4) PTCA( ) Urokinase : : , , 100mg~325mg : Beta-adrenergic blocking I. 7.

, . . 2 . , , . . ( 30ml). , , II. 1. 58 OO 5 . , 2 20 , 119 11 30 14 40 . 20~30 , . , .V/S 120/70 72 20 36.5 . : E4( )II. 2. 1) : Chest pain

S : .O : 2) : (Myocardial Infarction)

EKG : STEMI (ST-elevation myocardial infarction), PVC : Troponin-I , CK-MB : 20~30 , II. 3.

14 : 46 14 20 (chest pain) 14 46 EKG checked.14 : 47 Dr. . Q : ? A : 5 Q : ? ? A : . 30 Q : ? A : Q : ? A : . Q : ? A : II. 3.

14 : 47 Q : ? A : , . Q : ? A : N/S 1L IV Started on Lt arm(18G) BST : 115mg/dl checked. 14 : 50 patient monitor applied(SpO2 : 95%) O2 4L/min inhalation via nasal prong14 : 52 Chest pain . NTG 0.6mg (By Dr. checked).II. 3.

14 : 53 CIR pf. 14 : 55 Asprine 3T . Clopidogrel 8T . Heparine 400u IV Injected. N/S 1L + Heparine 20000u IV injected (40cc/hr Infusion )14 : 59 V/S : 113/73 68 19, SpO2 : 98%15 : 03 Dr. . Angio . ICU . Imp) MI15 : 10 V/S : 106/59 70 20 checked. 1EA prep send to Angio room : chart Angio CCU .II.

N/S 0.9%1LIV Nitroglycerin0.6mgPO, , , , Aspirine3TPO , , Clopidogrel8TPO, , , Heparine400uIV, GOT, GPT, Dopamin HCL()1EAIV, , , II. 4.

1)

2)

CPK0~170 U/L207Creatine phosphokinase . Troponin-I0~0.5ng/ml1.00 .CK-MB0.6~6.3ng/ml22.2II. 4.

3)

PT Sec12.0~15.0sec12.3Aspirine PT 109 , . Percentage80~100%109 INR0.8~1.2INR0.95aPTT25~40sec31.9II. 4. 4)

5) EKG STEMI (ST-elevation myocardial infarction) PVC()Chest PA

iii. : (2003). . 33 6 . . . MI .iii. : , , , , . . . .

iii. : 2001 7 6~ 11 9 1 : , (, ), : . 1 20 3 . , , , . .iii. . .iii. , CCU . , 3 1, 3 . , , , . .

iii. CCU . MI , CCU . . MI . . . iv. 11/30S : . 30 . .O : O : EKG STEMI (ST-elevation myocardial infarction) PVCS : ? .iv. 11/30 O : O2 4L/min nasal prong S : .O : . NTG S : PTCA ?O : PTCA .v. 1. : 2. . 30 . .3. : EKG : STEMI (ST elevation myocardial infarction), PVC : Troponin-I , CK-MB

v. 4. : (NANDA 12 : (Comfort)5. : .6. NO 1 , , . . . 20, 120/70, 72 .v. NO 2 . .O2 4L/min nasal prong .3 .15~20 . .NTG .4 . . .5 . . .v. 7.

. NTG , .VI. (2008). (2008). ECG. (2009). II. PCN (2009). PCN 3 . ER (2003). . 33 6

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