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Coronary Heart Disease

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Coronary Heart Disease Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. CARDIOVASCU LAR DISORDERS Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. MAIN OBJECTIVE • To promote health, prevent illnesses diagnose and manage patients suffering from common cardiovascular disorders. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Specific Objectives • Define concepts in cardiovascular system • Recognize individuals with disorders of the cardiovascular system • Describe common disorders of the cardiovascular system • Demonstrate ability to care for individuals with common disorders of the cardiovascular system Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. COURSE OUTLINE • Congestive cardiac failure (CCF) • Arteriosclerosis • Atherosclerosis • Intermittent claudication • Myocardial infarction • Rheumatic heart disease • Sub-acute bacterial endocarditis • Acute bacterial myocarditis • Hypertension • Coronary artery disease • Deep venous thrombosis Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. INTRODUCTION • Heart diseases are major cause of death but not all kinds are fatal. • There are many causes as covered under various conditions. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. DIAGNOSTIC TESTS • Electrocardiogram G) • X-ray • Angiogram • Heart catheterization • Central venous pressure • Radio-Isotopes • Echocardiography • Phonocardiography Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. CONGESTIVE CARDIAC FAIRULE • is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Pathophysiology • amount of blood pumped by the heart is insufficient to meet the body needs. • The right ventricle fails to function properly, the right atrium becomes engorged leading to congestion in the venous system. • The pressure in the superior and inferior venacava rises. The veins in the neck are distended, the liver becomes engorged and the legs become oedematous. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. SPECIFIC SYMPTOMS • Left sided failure;-Cardinal sign- dyspnoea • Right sided failure;-CS-oedema • Pulmonary oedema;-occurs as a result of accumulation of fluid within the lung tissue due to the left sided failure, presents with;- severe dyspnoea, coughing up bloody stained sputum. • Acute pulmonary oedema can be fatal within a short period of time and presents with;- Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. • Sudden onset of breathlessness • Signs of suffocation • Cyanosis • Cold hands • Distended neck veins tachycardia • Incessant coughing • Increasing mucoid sputum • Noisy respirations i.e. crackles Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. • TachycardSiaYMPTOMS • Palpitations • Arrhythmia • Dyspnoea • Ascites • Cyanosis • Distended jugular vein • Pitting oedema • Chest pain • Coughing /haemoptsis • Nausea and vomiting • Oliguria Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. GENERAL MANAGEMENT AIM • To relieve symptoms and reduce venous return to the heart Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. • . • • Oxygen administration • Sedation • Rest • Diet • Skin care • Medication ;- digitalis e.g. digoxin •Diuretics;-furesimide •Analgesics;-morphine • Rehabilitation Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. • Adequate exercise • A • Tobacco smoking • Stress • Treatment of URTI Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. HOSPITAL MANAGEMENT On admission • Bed rest • Prop-up • Oxygen administration if dyspnoeic or cyanosed • Total nursing care • Vital observations;- 1 hourly later 4 hourly • Medication;- Digitalis(digoxin) Diuretics Analgesics Potassium chloride • Daily weighing • Diet – light, low salt, easily digestible. • Pressure area care Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. - advice on;- • Rest • Low salt, high potassium diet • Compliance to drugs • Follow up • Effects in pregnancy in women Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. DISEASES OF THE ARTERIES ATHEROSCLEROSIS AND ARTERIOSCLEROSIS ATHEROSCLEROSIS • Is a disease of the arteries in which fatty plagues develop on their inner walls, eventually obstructing blood flow and interfering with absorption of nutrients. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. ARTERIOSCLEROSIS • Literally means hardening of arteries with loss of elasticity within the middle layer of the small arteries, causing impaired blood supply to the organs and severe elevation of blood pressure. • It is associated with some degree of athroma and old age. • Although the processes of atherosclerosis and arteriosclerosis differ, rarely does one occur without the other Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Pathophysiology • It’s a disease of artery in which fatty plaques develop in the internal layer of medium and large artery eventually obstructing blood flow. The deposits interfere with absorption of nutrients by the endothelial cells that compose the lining and protrude into the lumen obstructing blood flow. • There is accumulation of smooth muscle cells, fat plaques with lipids, fatty acids, cholesterol calcium crystal, carbohydrates, blood components and fibrous tissue. • Secondary changes can occur as a result of arterial dilatation and Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Atherosclerosis Modifiable • Nicotine use (i.e., tobacco smoking, chewing) • Diet (contributing to hyperlipidemin) • Hypertension • Diabetes (which speeds the atherosclerotic process by thickening the basement membranes of both large and small vessels) • Stress • Sedentary lifestyle Non modifiable • Age • Gender Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Effects of atherosclerotic plaques • Narrowing the arterial lumen to cause ischaemia • Sudden occluding of the lumen by thrombosis causing infarction • Providing a site for thrombosis then embolism • Forming an aneurism then rupturing • Effects occur most frequently in the heart, the brain, the kidneys, intestines. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Prevention • Reduce fat ingestion • Reduce cholesterol intake • Quit smoking • Exercises • Medication to reduce lipid levels;- atorvastatin, nicotinic acid Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Intermittent Claudication • A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. • The pain result from built up of metabolic waste within the muscle tissue. • There is local irritation by this toxic waste causing ischemic pain. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Mechanism Of Intermittent Claudication Activity/exercise ?Increased tissue oxygen demand ?impaired oxygen supply due to obstruction ?shift to anaerobic metabolism ? build up of metabolic waste ? local irritation of peripheral nerve endings ? pain in extremity ?rest ? decreased tissue oxygen demand ? return to aerobic metabolism ? elimination of metabolic waste ? relief of pain. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Diagnosis • Peripheral pulses;- e.g. poplitial pulse, dorsalis pedis pulse • Doppler ultrasound Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. General management • Give bed rest • Provide warmth to cold extremities • Elevate the feet • Moderate regular exercises for the limbs • Skin care • Low fat diet • Stop smoking Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Medication • Vasodilators;- nifedipine • Nicotinic acid;- antilipemic to decrease serum lipids • Antiplatelets;- aspirin • Thrombolitics;- heparin Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Surgical intervention Peripheral Arterial Bypass Surgery • Synthetic graft is anstomosed to a patent arterial source both proximal and distal to the lesion. Complications;- • Infection • Graft failure • Amputation Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Percutaneous Transluminal Angioplasty (PTA) • This use of a small catheter with an inflatable balloon is passed though the vessel to compress the lesion and widen the lumen followed by anticoagulation therapy. Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. Nursing Care • Surgical cleaning of wounds • Antibiotics;- prophylaxis/treatment. • Vital observations • Pain management • Psychological support • Support lifestyle changes to Please purchase PDFcamp Printer on http://www.verypdf.com/ to remove this watermark. The Patient Who Has Peripheral Arterial Insufficiency Nursing Process Nursing Diagnosis • Ineffective peripheral tissue perfusion
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