Cardio vasculas system disorder ibro.pptx

CVS medical surgical

1. 4.3 Cardiovascular System disorders Health History When conducting a health assessment of the cardiovascular system, a thorough history should include the following: Any past history of chest pain, shortness of breath, alcoholism and/or tobacco use, anemia, rheumatic fever, strepatientococcal sore throat, congenital heart disease, stroke, hypertension, thrombophlebitis, and edema Current and past use of medications 1/8/2024 Ibrahim A(BscN) 1

2. Information about specific treatments, past surgeries, or hospital admissions related to cardiovascular problems Information about cardiovascular risk factors (i.e., elevated serum lipids, hypertension) The patient’s current weight and weight history The number of pillows needed for comfort Information about stressful situations should be explored (e.g., marital relationships) 1/8/2024 Ibrahim A(BscN) 2

3. Physical Examination General appearance, and vital signs Inspection of the skin, extremities, and the large veins of the neck Auscultation of the heart with stethoscope Diagnostic Studies Chest x-ray Electrocardiogram 1/8/2024 Ibrahim A(BscN) 3

4. Hypertension Hypertension, or high blood pressure (BP), is defined as a persistent systolic blood pressure (SBP) greater than or equal to 140 mm Hg, diastolic blood pressure (DBP) greater than or equal to 90 mm Hg. BP is the force exerted by the blood against the walls of the blood vessel. It must be adequate to maintain tissue perfusion during activity and rest . 1/8/2024 Ibrahim A(BscN) 4

5. Etiology of Hypertension Primary (essential or idiopathic) hypertension: elevated BP without an identified cause; accounts for 90% to 95% of all cases of hypertension. Secondary hypertension: elevated BP with a specific cause; accounts for 5% to 10% of hypertension in adults. 1/8/2024 Ibrahim A(BscN) 5

6. Clinical Manifestations Physical examination may reveal no abnormalities other than high blood pressure. In severe hypertension, papilledema (swelling of the optic disc) may be seen. People with hypertension can be asymptomatic and remain so for many years. Coronary artery disease with angina or myocardial infarction is a common consequence of hypertension. Pathologic changes in the kidneys (indicated by increased blood urea nitrogen [BUN] and creatinine levels). Cerebrovascular involvement may lead to a stroke or ischemic attack , 1/8/2024 Ibrahim A(BscN) 6

7. Manifested by alterations in vision or speech, dizziness, weakness, a sudden fall, or temporary paralysis on one side (hemiplegia). Often called the “silent killer” because it is frequently asymptomatic until it becomes severe and target organ disease occurs. Target organ diseases occur in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vasculature (peripheral vascular disease), kidney (nephrosclerosis), and eyes (retinal damage). aneurysm. 1/8/2024 Ibrahim A(BscN) 7

8. Hypertension is a major risk factor for coronary artery disease (CAD). Hypertension is a major risk factor for cerebral atherosclerosis and stroke. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels, Leading to the development of peripheral vascular disease, aortic 1/8/2024 Ibrahim A(BscN) 8

9. Diagnostic Studies Routine urinalysis, BUN, serum creatinine, and creatinine clearance levels are used to screen for renal involvement. Lipid profile provides information about additional risk factors that predispose to atherosclerosis and cardiovascular disease. ECG and echocardiography provide information about the cardiac status. Blood pressure monitoring. 1/8/2024 Ibrahim A(BscN) 9

10. Medical Management The goal of hypertension treatment is to prevent death and complications by achieving and maintaining the arterial blood pressure at 140/90 mm Hg or lower. For patients with uncomplicated hypertension and no specific indications for another medication, the recommended initial medications include diuretics, beta-blockers, or both. Patients are first given low doses of medication. If blood pressure does not fall to Less than 140/90 mm Hg, the dose is increased gradually. Alpha Blocker prazosin hydrochloride (Minipress) Action Peripheral vasodilator acting directly on the blood vessel; similar to hydralazine 1/8/2024 Ibrahim A(BscN) 10

11. Contraindications: Angina pectoris and coronary artery disease. Induces tachycardia if not preceded by administration of propranolol and a diuretic. Occasional vomiting and diarrhea, Urinary frequency, and cardiovascular collapse. Patients occasionally experience drowsiness, lack of energy, and weakness. 1/8/2024 Ibrahim A(BscN) 11

12. Vasodilators fenoldopam mesylate Given intravenously for hypertensive emergencies. Action Stimulates dopamine and alpha-2 adrenergic receptors Contraindication Use with caution in persons with glaucoma, recent stroke (brain attack), asthma, hypokalemia, or diminished liver function. Side effect Headache, hypotension, sweating 1/8/2024 Ibrahim A(BscN) 12

13. Hydralazine hydrochloride (Apresoline) Action Decreases peripheral resistance but concurrently elevates cardiac output Acts directly on smooth muscle of blood vessels 1/8/2024 Ibrahim A(BscN) 13

14. Contraindication Not used as initial therapy; used in combination with other medications. Angina or coronary disease, congestive heart failure, hypersensitivity Side effect Headache, tachycardia, and dyspnea may occur 1/8/2024 Ibrahim A(BscN) 14

15. Diuretics Thiazide diuretics (such as bendroflumethiazide) and (chlorthalidone and indapamide) are cheap, easy to use, and can be given once daily. They are effective and are the drugs of choice in elderly people. Thiazides reduce blood pressure by increasing excretion of sodium and water. 1/8/2024 Ibrahim A(BscN) 15

16. Non pharmacological treatment Maintain normal body weight for adults (body mass index 20–25 kg/m2) Reduce dietary sodium intake to (6 g/day Engage in regular aerobic physical activity, such as walking (30 minutes per day on most days of the week) Limit alcohol consumption. Consume a diet rich in fruit and vegetables. Consume a diet with low levels of saturated fat A complete history is obtained to assess for symptoms that indicate target organ damage. Such symptoms may include: Angina pain; shortness of breath; alterations in speech, vision, or balance; nosebleeds; headaches; dizziness; or nocturia. 1/8/2024 Ibrahim A(BscN) 16

17. Nursing process Diagnosis NURSING DIAGNOSES Based on the assessment data, nursing diagnoses for the patient may include the following: Deficient knowledge regarding the relation between the treatment regimen and control of the disease process Noncompliance with therapeutic regimen related to side effects of prescribed therapy 1/8/2024 Ibrahim A(BscN) 17

18. Collaborative Problems/Potential Complications Based on the assessment data, potential complications that may develop include the following: Left ventricular hypertrophy Myocardial infarction Heart failure Cerebrovascular accident (stroke or brain attack) 1/8/2024 Ibrahim A(BscN) 18

19. Nursing Interventions The objective of nursing care for hypertensive patients focuses on lowering and controlling the blood pressure without adverse effects and without undue cost. To achieve these goals, the nurse must support and teach the patient to adhere to the treatment regimen by implementing necessary lifestyle changes. 1/8/2024 Ibrahim A(BscN) 19

20. Increasing Knowledge The patient needs to understand the disease process and how lifestyle changes and medications can control hypertension. The nurse needs to emphasize the concept of controlling hypertension rather than curing it. The nurse can encourage the patient to restrict sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. 1/8/2024 Ibrahim A(BscN) 20

21. Coronary artery disease (CAD) Coronary artery disease (CAD) i s a type of blood vessel disorder included in the general category of atherosclerosis. Atherosclerosis is characterized by a focal deposit of cholesterol and lipids within the wall of the artery. Risk factors: Non modifiable risk factors are age, gender, and genetic inheritance. Modifiable risk factors include: Elevated serum lipids, hypertension, tobacco use, physical inactivity, obesity, diabetes. Lipids combine with proteins to form lipoproteins and are vehicles for fat mobilization and transport. The different types of lipoproteins are classified as high-density lipoproteins (HDLs), low-density lipoproteins (LDLs), and very-low-density lipoproteins (VLDLs). 1/8/2024 Ibrahim A(BscN) 21

22. HDLs carry lipids away from arteries and to the liver for metabolism. HDL levels are increased by physical activity, moderate alcohol consumption, and estrogen administration. Elevated LDL levels correlate most closely with an increased incidence of atherosclerosis and CAD. Tobacco use is also a major risk factor in CAD. Obesity. Diabetes. Certain behavioral states (i.e., stress) have also been found to be contributing risk factors for CAD. 1/8/2024 Ibrahim A(BscN) 22

23. Prevention of CAD Persons with a serum cholesterol level greater than 200 mg/dl are at high risk for CAD. A regular physical activity program should be implemented. Therapeutic lifestyle changes to reduce the risk of CAD include: Lowering LDL cholesterol by adopting a diet that limits saturated fats and cholesterol and emphasizes complex carbohydrates (e.g., whole grains, fruit, vegetables). Low-dose aspirin is recommended for people at risk for CAD. Common side effects of aspirin therapy include GI upset and bleeding. 1/8/2024 Ibrahim A(BscN) 23

24. Chronic Angina Chronic angina refers to chest pain that occurs intermittently over a long period. Angina is rarely sharp, and it usually does not change with position or breathing. Many people with angina complain of indigestion or a burning sensation in the epigastric region. Anginal pain usually lasts for only a few minutes (3 to 5 minutes) and commonly subsides when the precipitating factor is relieved. Pain at rest is unusual. 1/8/2024 Ibrahim A(BscN) 24

25. The treatment of chronic angina is aimed at decreasing oxygen demand and/or increasing oxygen supply and reducing CAD risk factors. The most common drugs used to manage chronic angina are nitrates. Short-acting nitrates are first-line therapy for the treatment of angina. Nitrates produce their principal effects by dilating peripheral blood vessels. 1/8/2024 Ibrahim A(BscN) 25

26. B-Adrenergic blockers are the preferred drugs for the management of chronic s angina. Calcium channel blockers are used if b-adrenergic blockers are contraindicated. The primary effects of calcium channel blockers are: (1) systemic vasodilation (2) decreased myocardial contractility, and (3) coronary vasodilation. 1/8/2024 Ibrahim A(BscN) 26

27. Acute Coronary Syndrome Acute coronary syndrome develops when ischemia is prolonged and not immediately reversible. Unstable angina (UA) is chest pain that is new in onset, occurs at rest, or has a worsening pattern. 1/8/2024 Ibrahim A(BscN) 27

28. Myocardial infarction (MI) occurs as a result of sustained ischemia, causing irreversible myocardial cell death. Eighty percent to 90% of all MIs are due to the development of a thrombus. Contractile function of the heart stops in the infracted area(s). Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration. The pain is usually described as a heaviness, pressure, tightness, or burning. 1/8/2024 Ibrahim A(BscN) 28

29. Complications after MI The most common complication after an MI is dysrhythmias. Heart failure occurs when the pumping power of the heart has diminished. Cardiogenic shock Drug Therapy Initial management of the patient with chest pain includes aspirin, sublingual nitroglycerin, morphine sulfate for pain unrelieved by nitroglycerin, and oxygen. IV nitroglycerin, aspirin, b-adrenergic blockers, and systemic anticoagulation. Heparin are the initial drug treatments of choice. 1/8/2024 Ibrahim A(BscN) 29

30. Nursing Management The following nursing measures should be instituted for a patient experiencing angina: Administration of supplemental oxygen. Determination of vital signs. Prompt pain relief first with a nitrate followed by an opioid analgesic if needed. Comfortable positioning of the patient. Physiologic monitoring, promotion of rest and comfort. 1/8/2024 Ibrahim A(BscN) 30

31. Sudden Cardiac Death Sudden cardiac death (SCD) is unexpected death from cardiac causes. CAD is the most common cause of SCD and accounts for 80% of all SCDs. SCD involves, producing an abrupt loss of cardiac output and cerebral blood flow. Death usually occurs within 1 hour of the onset of acute symptoms (e.g., angina, palpitations). The majority of cases of SCD are caused by acute ventricular dysrhythmias (e.g., ventricular tachycardia, ventricular fibrillation). 1/8/2024 Ibrahim A(BscN) 31

32. Etiology and Pathophysiology Heart failure (HF) is an abnormal clinical condition involving impaired cardiac pumping Risk factors include: Coronary artery disease (CAD) and advancing age. Hypertension, diabetes, cigarette smoking, obesity, and high serum cholesterol also contribute to the development of HF. 1/8/2024 Ibrahim A(BscN) 32

33. Classification Heart failure is classified as systolic or diastolic failure. Systolic failure, the most common cause of HF, results from an inability of the heart to pump blood. Diastolic failure is an impaired ability of the ventricles to relax and fill during diastole. Decreased filling of the ventricles will result in decreased stroke volume and cardiac output (CO). 1/8/2024 Ibrahim A(BscN) 33

34. The most common form of HF is left-sided failure from left ventricular dysfunction. Blood backs up into the left atrium and into the pulmonary veins causing pulmonary congestion and edema. Clinical Manifestations Common symptoms include: Fatigue, dyspnea, tachycardia, Edema, and unusual behavior. 1/8/2024 Ibrahim A(BscN) 34

35. Complication Pleural effusion, atrial fibrillation, thrombus formation, renal insufficiency, and hepatomegaly are all complications of HF. Diagnostic Studies A thorough history, physical examination, chest x-ray, electrocardiogram (ECG), and echocardiogram. 1/8/2024 Ibrahim A(BscN) 35

36. Management for heart failure The goals of therapy for HF are to decrease patient symptoms, improve quality of life, and decrease mortality and morbidity. Treatment strategies should include the following: Decreasing intravascular volume with the use of diuretics to reduce venous return and preload. Decreasing venous return (preload) to reduce the amount of volume returned to the LV during diastole. Decreasing after load (the resistance against which the LV must pump) improves CO and decreases pulmonary congestion. Reduction of anxiety is an important nursing function, since anxiety may increase the SNS response and further increase myocardial workload. 1/8/2024 Ibrahim A(BscN) 36

37. Chronic Heart Failure The main goal in the treatment of chronic HF is to treat the underlying cause and contributing factors, maximize Cardiac out put. Provide treatment to alleviate symptoms, improve ventricular function. Improve quality of life, preserve target organ function, and improve mortality and morbidity. Administration of oxygen improves saturation and assists greatly in meeting tissue oxygen needs and helps relieve dyspnea and fatigue. Physical and emotional rest allows the patient to conserve energy and decreases the need for additional oxygen. The degree of rest recommended depends on the severity of HF. 1/8/2024 Ibrahim A(BscN) 37

38. General therapeutic objectives for drug management of chronic HF include: Identification of the type of HF and underlying causes Correction of sodium and water retention and volume overload Reduction of cardiac workload Improvement of myocardial contractility. Diuretics are used in HF to mobilize edematous fluid, reduce pulmonary venous pressure. 1/8/2024 Ibrahim A(BscN) 38

39. General therapeutic objectives for drug management of chronic HF include: Identification of the type of HF and underlying causes Correction of sodium and water retention and volume overload Education of cardiac workload Improvement of myocardial contractility. Diuretics are used in HF to mobilize edematous fluid, reduce pulmonary venous pressure. Thiazide diuretics may be the first choice in chronic HF because of their convenience, safety, low cost, and effectiveness. Vasodilator therapy in the treatment of HF: 1/8/2024 Ibrahim A(BscN) 39

40. Major effect increasing venous capacity Slowing the process of ventricular dysfunction Decreasing heart size Nitrates are used to treat HF by acting directly on the smooth muscle of the vessel wall. Major effects include a vasodilation of coronary arteries. Digitalis glycosides [e.g., digoxin (Lanoxin)] remain the mainstay in the treatment of HF, however, they have not been shown to prolong life. 1/8/2024 Ibrahim A(BscN) 40

41. Nursing Management Diet education and weight management are critical to the patient’s control of chronic HF. Assisting the patient to adapt to both the physiologic and psychologic changes, and Integrating the patient and the patient’s family or support system in the overall care plan. Many patients with HF are at high risk for anxiety and depression, and major. Patients should be taught how to take their pulse rate and to know under what circumstances drugs, especially digitalis, should be withheld if pulse rate is below 60 beats per minute.. Patients should be taught the symptoms of hypo- and hyperkalemia if diuretics that deplete or spare potassium are being taken. Frequently the patient who is taking thiazide or loop diuretics is given supplemental potassium. 1/8/2024 Ibrahim A(BscN) 41

42. Dysrhythmias The ability to recognize normal and abnormal cardiac rhythms, called dysrhythmias. Four properties of cardiac cells (automaticity, excitability, conductivity, and contractility) enable the conduction system to initiate an electrical impulse, transmit it through the cardiac tissue, and stimulate the myocardial tissue to contract. A normal cardiac impulse begins in the sinoatrial (SA) node in the upper right atrium. 1/8/2024 Ibrahim A(BscN) 42

43. The impulse then travels to the atrioventricular (AV) node through the bundle of His and down the left and right bundle branches, ending in the Purkinje fibers, which transmit the impulse to the ventricles, resulting in ventricular contraction. The autonomic nervous system plays an important role in the rate of impulse formation, The parasympathetic nervous system and fibers of the sympathetic nervous system. 1/8/2024 Ibrahim A(BscN) 43

44. Normal sinus rhythm refers to a rhythm that originates in the SA node and follows the normal conduction pattern of the cardiac cycle. The P wave represents the depolarization of the atria (passage of an electrical impulse through the atria), causing atrial contraction. The PR interval represents the time period for the impulse to spread through the atria, AV node, bundle of His, and Purkinje fibers. 1/8/2024 Ibrahim A(BscN) 44

45. The QRS complex represents depolarization of the ventricles (ventricular contraction), and the QRS interval represents the time it takes for depolarization. The ST segment represents the time between ventricular depolarization and repolarization. The T wave represents repolarization of the ventricles. The QT interval represents the total time for depolarization and repolarization of the ventricles. 1/8/2024 Ibrahim A(BscN) 45

46. Mechanisms of Dysrhythmias Normally the main pacemaker of the heart is the SA node, which spontaneously discharges 60 to 100 times per minute. Disorders of impulse formation can cause dysrhythmias. A pacemaker from another site can lead to dysrhythmias. Secondary pacemakers may originate from the AV node or His-Purkinje system. Triggered beats (early or late) may come from an ectopic focus (area outside the normal conduction pathway) in the atria, AV node, or ventricles. 1/8/2024 Ibrahim A(BscN) 46

47. Types of Dysrhythmias Sinus bradycardia has a normal sinus rhythm, but the SA node fires at a rate less than 60 beats/minute and is referred to as absolute bradycardia. Clinical associations Sinus bradycardia may be a normal sinus rhythm (e.g., in hypothermia, and administration of parasympathomimetic drugs. Disease states associated with sinus bradycardia are: increased intracranial pressure, obstructive jaundice, and myocardial infarction (MI). 1/8/2024 Ibrahim A(BscN) 47

48. Treatment Administration of atropine (an anticholinergic drug) for the patient with symptoms. Sinus tachycardia Sinus tachycardia has a normal sinus rhythm, but the SA node fires at a rate greater than 100 beats/minute as a result of vagal inhibition or sympathetic stimulation. 1/8/2024 Ibrahim A(BscN) 48

49. Clinical manifestation Sinus tachycardia is associated with physiologic and psychologic stressors such as exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, heart failure (HF), anxiety, and fear. It can also be an effect of certain drugs. 1/8/2024 Ibrahim A(BscN) 49

50. Atrial fibrillation Atrial fibrillation is characterized by a total disorganization of atrial electrical activity resulting in loss of effective atrial contraction. Atrial fibrillation usually occurs in the patient with underlying heart disease, such as CAD, rheumatic heart disease, hypertensive heart disease, HF, and pericarditis. 1/8/2024 Ibrahim A(BscN) 50

51. It can be caused by thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and cardiac surgery. Atrial fibrillation can often result in a decrease in CO, and thrombi may form in the atria as a result of blood stasis. An embolized clot may develop and pass to the brain, causing a stroke. 1/8/2024 Ibrahim A(BscN) 51

52. Junctional dysrhythmias refer to dysrhythmias that originate in the area of the AV node, primarily because the SA node has failed to fire or the signal has been blocked. In this situation, the AV node becomes the pacemaker of the heart. Junctional dysrhythmias are often associated with CAD, HF, electrolyte imbalances, MI, and rheumatic heart disease. Certain drugs (e.g., digoxin, amphetamines, caffeine, nicotine) can also cause junctional dysrhythmias. 1/8/2024 Ibrahim A(BscN) 52

53. Premature ventricular contraction (PVC) is a contraction originating in an ectopic focus in the ventricles. PVCs are associated with stimulants such as caffeine, alcohol, nicotine, epinephrine, and digoxin. They are also associated with electrolyte imbalances, hypoxia, fever, exercise, and emotional stress. 1/8/2024 Ibrahim A(BscN) 53

54. Disease states associated with PVCs include MI, mitral valve prolapse, HF, and CAD. PVCs may reduce the CO and precipitate angina and HF. Treatment is often based on the cause of the PVCs (e.g., oxygen therapy for hypoxia, electrolyte replacement). Drugs that can be considered include b-adrenergic blockers. 1/8/2024 Ibrahim A(BscN) 54

55. Ventricular tachycardia (VT) is a run of three or more PVCs. It occurs when an ectopic focus fire repetitively and the ventricle takes control as the pacemaker. VT is a life-threatening dysrhythmia because of decreased CO. VT is associated with MI, CAD, significant electrolyte imbalances, mitral valve prolapse, and digitalis toxicity. 1/8/2024 Ibrahim A(BscN) 55

56. Treatment. Precipitating causes must be identified and treated (e.g., electrolyte imbalances, ischemia). Ventricular fibrillation (VF) is a severe interruption of the heart rhythm characterized on ECG. Mechanically the ventricle is simply “quivering,” (shake) and no effective contraction, and consequently no CO, occurs. VF occurs in acute MI and myocardial ischemia and in chronic diseases such as CAD. VF results in an unresponsive, pulseless, and apneic state. If not rapidly treated, the patient will die. Treatment Consists of immediate initiation of CPR and advanced cardiac life support (ACLS) measures with the use of defibrillation. 1/8/2024 Ibrahim A(BscN) 56

57. PACEMAKERS The artificial cardiac pacemaker is an electronic device used to pace the heart when the normal conduction pathway is damaged or diseased. A permanent pacemaker is one that is implanted totally with in the body. A specialized type of cardiac pacing has been developed for the management of HF. A temporary pacemaker is one that has the power source outside the body. 1/8/2024 Ibrahim A(BscN) 57

58. Patients with temporary or permanent pacemakers will be ECG monitored to evaluate the status of the pacemaker. Complications of temporary or permanent pacemaker Infection and hematoma formation at the site of insertion. symptomatic bradycardia, perforation of the atrial or ventricular septum by the pacing 1/8/2024 Ibrahim A(BscN) 58

59. Syncope Syncope, a brief lapse in consciousness (fainting). The causes of syncope can be categorized as cardiovascular or non cardiovascular. Cardiovascular causes of syncope include: (1) neurocardiogenic syncope Dysrhythmias (e.g., tachycardias, bradycardias). Non cardiovascular causes can include: Hypoglycemia, hysteria. 1/8/2024 Ibrahim A(BscN) 59

60. Infective Endocarditis Infective endocarditis is an infection of the endocardial surface of the heart that affects the cardiac valves. Causative organisms Staphylococcus aureus and Streptococcus . Clinical manifestation Low-grade fever, chills, weakness, malaise, fatigue, and anorexia Arthralgias (pain in a joint), myalgias ( pain in a muscle), back pain, abdominal discomfort, weight loss, headache, and clubbing of fingers 1/8/2024 Ibrahim A(BscN) 60

61. Treatment Drug therapy consists of long-term treatment with IV antibiotic therapy with subsequent blood cultures to evaluate the effectiveness of antibiotic therapy. It is treated with penicillin. Fever is treated with aspirin, acetaminophen , ibuprofen, fluids, and rest. 1/8/2024 Ibrahim A(BscN) 61

62. MYOCARDITIS Myocarditis is inflammation of the myocardium. Cause Bacteria, fungi, radiation therapy, and pharmacologic and chemical factors. Myocarditis is frequently associated with acute pericarditis 1/8/2024 Ibrahim A(BscN) 62

63. Clinical manifestations include: Fever, fatigue, malaise, myalgias, dyspnea, lymphadenopathy, and Nausea and vomiting are early systemic manifestations. Late cardiac signs relate to the development of HF and may include jugular venous distention, syncope, peripheral edema, and angina. 1/8/2024 Ibrahim A(BscN) 63

64. Management Digoxin to treat ventricular failure Diuretics to reduce fluid volume Immunosuppressive therapy to reduce myocardial inflammation and to prevent irreversible myocardial damage. Oxygen therapy, bed rest, and restricted activity. 1/8/2024 Ibrahim A(BscN) 64

65. Nursing interventions: Nursing interventions include Assessing the level of anxiety. keeping the patient and family informed about therapeutic measures. 1/8/2024 Ibrahim A(BscN) 65

66. RHEUMATIC FEVER Rheumatic fever is an inflammatory disease of the heart potentially involving all layers of the heart. Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves. Acute rheumatic fever is a complication that occurs as a delayed treatment of a group A strepatientococcal pharyngitis and affects the heart, and joints . 1/8/2024 Ibrahim A(BscN) 66

67. Clinical manifestations of ARF include: Evidence of a preceding group A strepatientococcal infection. Murmurs of mitral or aortic regurgitation, or mitral stenosis Cardiac enlargement and HF Muscle weakness, and disturbances of speech and gait. Small, hard, painless swellings located over extensor surfaces of the joints. Fever, 1/8/2024 Ibrahim A(BscN) 67

68. polyarthralgia Laboratory findings: elevated ESR, elevated WBC prevention of rheumatic fever Early detection and treatment of group A strepatientococcal pharyngitis with antibiotics, specifically penicillin. The success of treatment requires strict adherence to the full course of antibiotic therapy. 1/8/2024 Ibrahim A(BscN) 68

69. Management The primary goals of managing a patient with ARF are: To control and eradicate the infecting organism. Prevent cardiac complications. Relieve joint pain, fever, and other symptoms with antibiotics; optimal rest; and antipyretics, NSAIDs, and corticosteroids. Secondary prevention aims at preventing the recurrence of rheumatic fever with monthly injections of long-acting penicillin. 1/8/2024 Ibrahim A(BscN) 69

70. Valvular Heart Disease Valvular stenosis refers to a constriction or narrowing of the valve opening. Valvular regurgitation (also called valvular incompetence or insufficiency) occurs with incomplete closure of the valve and results in the backward flow of blood. Mitral Valve Stenosis Adult mitral valve stenosis results from rheumatic heart disease. Less commonly, it can occur congenitally, from rheumatoid arthritis. Clinical manifestations of mitral stenosis include; Exertional dyspnea, fatigue, palpitations from atrial fibrillation 1/8/2024 Ibrahim A(BscN) 70

71. Mitral Regurgitation Mitral regurgitation (MR) is caused by MI, chronic rheumatic heart disease, mitral valve prolapse. In acute MR, there is a sudden increase in pressure and volume that is transmitted to the pulmonary bed, resulting in pulmonary edema and life-threatening shock. Clinical manifestations of acute MR include: Thready, peripheral pulses and cool, clammy extremities. Surgery considered before significant left ventricular failure or pulmonary hypertension develops. 1/8/2024 Ibrahim A(BscN) 71

72. Mitral Valve Prolapse Mitral valve prolapse is an abnormality of the mitral valve prolapse, back into the left atrium during systole. Clinical manifestations include : Murmur from regurgitation that gets more intense through systole, chest pain, dyspnea, palpitations, and syncope. Aortic Valve Stenosis In older patients, aortic stenosis is a result of rheumatic fever or senile fibrocalcific Degeneration.. Aortic stenosis results in left ventricular hypertrophy and increased myocardial oxygen consumption, and eventually, reduced cardiac output leading to pulmonary hypertension and HF. 1/8/2024 Ibrahim A(BscN) 72

73. Clinical manifestations include a systolic: Murmur, angina, syncope, and exertional dyspnea. 1/8/2024 Ibrahim A(BscN) 73

74. Aortic Valve Regurgitation Acute aortic regurgitation (AR) is caused by IE, trauma, or aortic dissection. Chronic AR is generally the result of rheumatic heart disease, a congenital bicuspid aortic valve, syphilis, or chronic rheumatic conditions. Clinical manifestations of acute AR include: Severe dyspnea, chest pain, and hypotension indicating left ventricular failure and shock that constitute a medical emergency. Clinical manifestations of chronic AR include: Exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea after considerable myocardial dysfunction has occurred. 1/8/2024 Ibrahim A(BscN) 74

75. ANEURYSMS Aneurysms are dilations of the arterial wall. Causes of aortic aneurysms Degenerative, congenital, inflammatory, or infectious. Aortic aneurysms may involve the aortic arch, thoracic aorta, and/or abdominal aorta, but most are found in the abdominal aorta. 1/8/2024 Ibrahim A(BscN) 75

76. Clinical manifestation Thoracic aorta aneurysms: The most common manifestations are deep, diffuse chest pain that may extend to the interscapular area Hoarseness as a result of pressure on the recurrent laryngeal nerve; and dysphagia from pressure on the esophagus. Abdominal aortic aneurysms: symptoms include pain associated with abdominal disorders Management The goal of management is to prevent the aneurysm from rupturing. Surgical repair incising the diseased segment of the aorta 1/8/2024 Ibrahim A(BscN) 76

77. VENOUS THROMBOSIS Venous thrombosis is the most common disorder of the veins and involves the formation of a thrombus (clot) in association with inflammation of the vein. Superficial thrombophlebitis occurs in about 65% of all patients receiving IV therapy . Deep vein thrombosis involves a thrombus in a deep vein, most commonly the Iliac and femoral veins and can result in embolization of thrombi to the lungs. Clinical manifestation Superficial thrombophlebitis presents as a palpable, firm, vein. The area surrounding the vein may be tender to the touch, reddened, and warm. A mild systemic temperature elevation and leukocytosis may be present. 1/8/2024 Ibrahim A(BscN) 77

78. Management: Management of superficial thrombophlebitis includes: elevating the affected extremity to promote venous return and decrease the edema and applying warm, moist heat. Anticoagulation Nursing diagnoses for the patient with venous thrombosis include the following: Acute pain related to venous congestion, impaired venous return, and inflammation Ineffective health maintenance related to lack of knowledge about the disorder and its treatment Risk for impaired skin integrity related to altered peripheral tissue perfusion 1/8/2024 Ibrahim A(BscN) 78

79. Potential complication: Bleeding related to anticoagulant therapy Pulmonary embolism related to embolization of thrombus, and immobility Goals for the patient with venous thrombosis include: Relief of pain decrease edema, no skin ulceration no complications from anticoagulant therapy no evidence of pulmonary emboli. 1/8/2024 Ibrahim A(BscN) 79

80. Nursing intervention Patients on warfarin should be instructed to follow a consistent diet of foods containing vitamin K and to avoid any additional supplements that contain vitamin K. Exercise programs should be developed with an emphasis on walking, and swimming. The expected outcomes for the patient with venous thrombosis include: (1) minimal to no pain (2) intact skin (3) no signs of hemorrhage or occult bleeding (4) no signs of respiratory distress. 1/8/2024 Ibrahim A(BscN) 80

81. Cerebrovascular accident Cerebrovascular accident (CVA), or “stroke,” is the interruption of normal blood flow in one or more of the blood vessels that supply the brain. The tissues become ischemic, leading to hypoxia or anoxia with destruction or necrosis of the neurons. A CVA is an acute neurological injury that occurs because of changes in the blood vessels of the brain. 1/8/2024 Ibrahim A(BscN) 81

82. The changes can be intrinsic to the vessel (atherosclerosis, inflammation, dilation of the vessel, weakening of the vessel, obstruction of the vessel) Extrinsic, such as when an embolism travels from the heart. Total cessation of blood flow produces irreversible brain infarction within 3 minutes. Once the blood flow stops, cerebral edema, and alterations in local blood flow contribute to neuron dysfunction and death. 1/8/2024 Ibrahim A(BscN) 82

83. Complications of CVA include: Unstable blood pressure, sensory and motor impairment, infection (encephalitis), pneumonia, contractures, and pulmonary emboli. Causes Thrombosis, embolism, and hemorrhage are the primary causes of CVA. In cerebral thrombosis, the most common cause of CVA, a blood clot obstructs a cerebral vessel. Hemorrhagic CVA results from hypertension, rupture of an aneurysm, arteriovenous malformations, or bleeding disorder 1/8/2024 Ibrahim A(BscN) 83

84. Clinical manifestation Memory loss (amnesia). Speech difficulties (aphasia). visual difficulties such as double vision (diplopia) Defective vision, or blindness in the right or left halves of the visual fields of both eyes Inability to move the muscles (akinesia). Poor coordination, impairment of voluntary movement (dyskinesia). Muscular weakness or partial paralysis affecting one side of the body (hemiparesis). Or paralysis of one side of the body (hemiplegia). 1/8/2024 Ibrahim A(BscN) 84

85. Physical Examination If the patient appears unconscious, quickly determine his or her airway status and level of consciousness. Determine the level of orientation; ability to speech, hearing, and vision ability. Lightly touch the patient’s skin on various parts of the body to test skin sensations. Treatment The treatment needs to be initiated rapidly, within 6 hours of the onset of symptoms. Passive range-of-motion exercises on the affected side. 1/8/2024 Ibrahim A(BscN) 85

86. Cardiac Arrest Cardiac arrest occurs when the heart ceases to produce an effective pulse and blood circulation. Cause Ventricular tachycardia or ventricular fibrillation Bradycardia or AV block. when there is no heart rate at all (asystole) 1/8/2024 Ibrahim A(BscN) 86

87. Clinical Manifestations Consciousness, pulse, and blood pressure are lost immediately. Ineffective respiratory gasping may occur. The pupils of the eyes begin dilating within 45 seconds. Seizures may or may not occur. 1/8/2024 Ibrahim A(BscN) 87

88. Emergency Management Cardiopulmonary Resuscitation The ABCDs of basic cardiopulmonary resuscitation (CPR) are a irway, breathing, circulation, and defibrillation. Resuscitation consists of the following steps: 1. Airway: maintaining an open airway 2. Breathing: providing artificial ventilation by rescue breathing 3. Circulation: promoting artificial circulation by external cardiac compression 4. Defibrillation: restoring the heartbeat 1/8/2024 Ibrahim A(BscN) 88

89. Nursing Management The most reliable sign of cardiac arrest is the absence of a pulse. The carotid pulse is assessed. Valuable time should not be wasted taking the blood pressure, listening for the heartbeat CPR is performed initially only if the defibrillator is not immediately available. If the patient has not been defibrillated within 10 minutes, the chance of survival is close to zero. 1/8/2024 Ibrahim A(BscN) 89

90. Maintaining Airway and Breathing The first step in CPR is to obtain an open airway. Any obvious material in the mouth or throat should be removed. The chin is directed up and back, or the jaw (mandible) is lifted forward. The rescuer “looks, listens, and feels” for air movement. Two rescue ventilations over 3 to 4 seconds are provided using a bag-mask or mouth mask. The rescuer (facing the patient’s side) places the heel of one hand on the lower half of the sternum, two finger widths (3.8 cm ) from the tip of the xiphoid and positions the other hand on top of the first hand. The fingers should not touch the chest wall. The chest compression is two ventilations to every 30 cardiac compressions. 1/8/2024 Ibrahim A(BscN) 90

91. Lymphangitis and Lymphadenitis Lymphangitis is an acute inflammation of the lymphatic channels. It arises most commonly from a focus of infection in an extremity. Usually, the infectious organism is a hemolytic Streptococcus. Clinical manifestation The lymph nodes become enlarged, red, and tender (acute lymphadenitis). The nodes involved most often are those in the groin, axilla, or cervical region. 1/8/2024 Ibrahim A(BscN) 91

92. Lymphedema and Elephantiasis Lymph edemas are classified as primary (congenital malformations) or secondary (acquired obstructions). Tissue swelling occurs in the extremities because of an increased quantity of lymph that results from obstruction of lymphatic vessels. Initially, the edema is soft, pitting, and relieved by treatment. As the condition progresses, the edema becomes firm, non pitting, and unresponsive to treatment 1/8/2024 Ibrahim A(BscN) 92

93. The most common type is congenital lymphedema . The obstruction may be in the lymph nodes and the lymphatic vessels. Lymphatic obstruction usually is caused by chronic lymphangitis. Lymphatic obstruction caused by a parasite (filaria) is seen frequently in the tropics. This condition, in which chronic swelling of the extremity, is referred to as elephantiasis. 1/8/2024 Ibrahim A(BscN) 93

94. Medical Management The goal of therapy is to reduce and control the edema and prevent infection. Active and passive exercises assist in moving lymphatic fluid into the bloodstream. When the leg is affected, strict bed rest with the leg elevated may aid in mobilizing the fluids. As initial therapy, the diuretic furosemide (Lasix) is prescribed as needed to prevent the fluid overload that can result from the mobilization of extracellular fluid. If lymphangitis or cellulitis is present, antibiotic therapy is initiated. The patient is taught to inspect the skin for evidence of infection. 1/8/2024 Ibrahim A(BscN) 94

95. Surgical Management Surgery is performed if the edema is severe and uncontrolled by medical therapy. If mobility is severely compromised, or if infection persists. One surgical approach involves the excision of the affected subcutaneous tissue and fascia, with skin grafting to cover the defect. 1/8/2024 Ibrahim A(BscN) 95

96. Nursing Management Constant elevation of the affected extremity and observations for complications are essential. Complications may include: Abscess, and cellulitis. Unusual drainage or any inflammation around the wound margin may suggest infection and should be reported to the physician. The patient is informed that there may be a loss of sensation in the skin graft area. The patient is also instructed to avoid the application of heating pads or exposure to sun to prevent burns or trauma to the area. 1/8/2024 Ibrahim A(BscN) 96