partial exam 2

Pulmonary hypertension

(PH or PHTN) is a condition of increased blood pressure within the arteries of the lungs. Symptoms include shortness of breath, syncope, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise.

Cardiogenic Shock: Pharmacologic Therapy

- Dobutamine - Nitroglycerin - Dopamine - Other vasoactive medications - Antiarrhythmic medications

thrombophlebitis prevention

-avoid trauma to the vein at the time of IV insertion -observing the site after insertion -checking medication additives for compatibility

Isolated systolic hypertension

-can be caused by underlying conditions such as artery stiffness, an overactive thyroid (hyperthyroidism) or diabetes. Occasionally, it can be caused by heart valve problems. It is the most common form of high blood pressure in people older than age 65, but it is possible for younger people to be affected by this type of high blood pressure as well. -is defined as a systolic blood pressure (SBP) >140 mm Hg and a diastolic blood pressure (DBP) <90 mm Hg. The conventional teaching was that ISH did not merit any treatment.

thrombophlebitis signs and symptoms

-localized pain -redness -warmth -swelling around insertion site OR along the path of the vein -immobility of the extremity [swelling/discomfort] -sluggish flow rate of IV -fever -malaise -leukocytosis

thrombophlebitis treatment

-remove IV promptly - 3 times for 10 min: apply cold compress [decrease blood flow & increases platelet aggression (tissue healing)] -followed by warm compress [absorb fluid] -elevate extremity -restart the IV Line in the opposite extremity

pharmacological management to treat angina pectoris! Currently, there are three main types of drugs used:

1) Nitrates 2) Beta blockers 3) Calcium channel blockers

risk factors fro angina pectoris

1.Physical exertion Walking outdoors is the most common form of the exertions, that produce an attack. Isometric exertion of the arms as on raking leaves, painting or lifting heavy objects also causes exertional angina 2.Strong emotions Stimulate the sympathetic nervous system and increase the work of the heart. This result in an increase in HR, BP and myocardial contractility. 3.Temperature extremes: It may be either hot or cold,increases the workload of the heart. Blood vessels constricts in Response to cold climate. Blood vessel dilate hot stimulus. Cold weather also cause increased metabolism to maintain internal temperature regulation. 4.Cigarette Smoking: Causes vasoconstriction and an increased HR because of nicotine stimulations of the catecholamine releases. It also diminishes available oxygen by increasing level of carbon monoxide 5. Sexual Activity: increase the work load and sympathetic stimulation. In a person with severe CAD, the resulting extra workload of the heart may precipitate angina 6.Stimulants: Such as cocaine, cause increased HR and subsequent myocardial demand. Stimulation of catecholamine release is the precipitating Factor

Angina pectoris (acute coronary syndrome)

Angina Pectoris It is recurring acute chest pain or discomfort resulting from decreased blood supply to the heart muscle (myocardial ischemia).

Pathophysiology of Angina Pectoris

Angina pectoris is as a result of ischemia of the heart which is due to atherosclerosis of the coronary arteries which restricts blood flow to the myocardium. Due to myocardium ischemia, the myocardial tissues are deprived of oxygen and nutrients for the aerobic metabolism. As a result there is an inclusion of anaerobic metabolism which leads to accumulation of lactic acid Due to increase of lactic acid, myocardial nerve fibers are irritated and this transmit a pain message to the cardiac nerves and upper thoracic posterior nerve roots And all this leads to cardiac pain which is the angina pectoris

what major complication of PVD?

Arterial insufficiency ulcers

Beta Blockers

Beta blockers reduce the heart rate, blood pressure, and the force of contractions, thereby decreasing the amount of oxygen the heart requires to pump blood. Examples: atenolol, metoprolol, nadolol and propranolol. Side effects: Cardiac effects -- worsen heart failure, bradycardia Noncardiac effects -- constriction of airways, circulatory problems, Impotence, hallucinations, insomnia, and fatigue

medications for myocardial infaraction:

Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow through narrowed arteries. Thrombolytics are often used to dissolve clots. Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots from forming and existing clots from growing. Nitroglycerin can be used to widen your blood vessels. Beta-blockers lower your blood pressure and relax your heart muscle. This can help limit the severity of damage to your heart. ACE inhibitors can also be used to lower blood pressure and decrease stress on the heart. Pain relievers may be used to reduce any discomfort you may feel.

Calcium Channel Blockers

Calcium channel blockers dilate arteries and lower blood pressure, which decreases the force of contractions. They also dilate veins, reducing the amount of blood returning to the heart, which reduces the workload of the heart. Examples: amlodipine, nifedipine, nicardipine, verapamil and diltiazem. Side effects: flushing, dizziness and lightheadedness, headache, peripheral edema and depression of cardiac function (with non-dihydropyridines)

sign and symptoms of angina pectoris

Characteristics of Angina: Angina is a clinical syndrome characterized by discomfort in the chest, Jaw, shoulder, back or arm. Onset - Angina can develop quickly or slowly. Location: Nearly 90% of clients experience the pain as retrosternal or slightly to the left of the sternum Radiation: The pain usually radiates to the left shoulder and upper arm, and may then travel down the inner aspect of the left arm to the elbow, wrist and Fourth and Fifth fingers. The pain may also radiate to the right shoulder, neck, Jaw or epigastric region. Duration: Angina usually last less than 5 minutes. However, attack precipitated by a heavy meal or extreme anger may last 15 to 20 minutes. Sensation: Clients describe the pain of angina as squeezing, burning, pressing, choking, aching or bursting pressure. The clients often says the pain feels like gas, heart burn, or indigestion. Severity: The pain of angina is usually mild or moderate in severity. It is often called "discomfort", not "pain". Rarely is the pain described as "severe" General symptoms: Palpitation Sweating Dizziness Dyspnea Dry mouth Blurred vision

how does cardiogenic shock present itself?

Chest pain, dysrhythmia, fatigue, feeling of impending doom, pulmonary edema

unstable angina

Dangerous and requires emergency treatment. It is the rupture of the fibrous cap, leading to the blockage of the artery by clotted blood. Occurs with increasing frequency (progression) Affects the patient's life by not being able to work. Low response to therapy and could lead to MI. (HEART ATTACK) M-MORPHINE TO NUMB THE PATIENT (LAST INTERVENTION) O- OXYGEN N- Nitrates improve blood flow by relaxing and dilating veins and arteries, including the coronary arteries. A-Asprin(it helps to prevent blood clotting, keeping the narrowed arteries open and lowering the risk of a heart attack).

Hypertension

Disorder of chronically elevated BP Hypertension is a huge public health problem for several reasons: 1.) It is very common 2.) It is often asymptomatic 3.) It has potentially devastating consequences, as it is one of the most important risk factors for stroke, heart disease, kidney failure and increased risk of death

Is the following statement true or false? The primary goal in treating cardiogenic shock is to limit further myocardial damage.

False Rationale: The primary goal in treating cardiogenic shock is not to limit further myocardial damage. The primary goal in treating cardiogenic shock is to treat the oxygenation needs of the heart muscle.

peripheral vascular disease signs and symptoms

HTN -reduce urine output -kidney damage -gangrene -gastrointestinal symptoms -hypertension -Ischemia of both large and small intestines - Intermittent claudication (cramping pain in the leg)

stable angina

It is the most common type Induced by physical activity (increase demand of O2), or emotional stress. And can't be supplied because of partially occluded coronary artery caused by atherosclerosis) The pain is relieved by rest.

Nitrates

Nitrates improve blood flow by relaxing and dilating veins and arteries, including the coronary arteries. Examples: nitroglycerin and isosorbide dinitrate. Side effects: The most common side effects of nitrates are headache, lightheadedness, flushing, and an increase in heart rate.

Cardiogenic Shock: Nursing Management

Preventing cardiogenic shock Monitoring hemodynamic status Administering medications, IV fluids Maintaining intra-aortic balloon counter pulsation Ensuring safety, comfort

Atherosclerosis/Arteriosclerosis

SUBTYPE of arteriosclerosis termed athero once plaque and fatty acids invade hardened artery -narrowing of artery (arteriosclerosis) BECAUSE of plaque build up

Cardiogenic shock

Shock state resulting from impairment or failure of myocardium.

What is the difference between angina and myocardial infarction?

That is an (acute) myocardial infarction. Angina means Pain in the precodial (chest) area which usually occurs due to decreased blood supply to the cardiac (heart) tissue. While Myocardial infarction(MI) is the damage that has already occurred due to that decreased blood supply.

variant angina

Usually affects arteries already narrowed by atherosclerosis Occurs when a person is at rest or sleep The pain is induced from the spasm of the coronary artery. Thereby when the coronary artery is going to spasms it narrows the artery thus lowering the amount of blood to the heart. TREATMENT:The calcium channel blockers nifedipine, amlodipine, verapamil, and diltiazem effectively prevent coronary vasospasm and variant angina, and they should be administered in preference to beta blockers. Amlodipine may be preferable because of its long half-life.

peripheral vascular disease (PVD)

atherosclerosis(plaque build up) of the peripheral arteries -LE -common in elderly -seen with diabetes, hypertension, hyperlipidemia(high cholesterol)

referral and rationals atherosclerosis

check blood pressure more, address exercise and rest time needs, communication with physician

what happens when you have a myocardial infaraction?

commonly known as a heart attack, occurs when a portion of the heart is deprived of oxygen due to blockage of a coronary artery. Coronary arteries supply the heart muscle (myocardium) with oxygenated blood. Without oxygen, muscle cells served by the blocked artery begin to die (infarct).

malignant hypertension

is extremely high blood pressure that develops rapidly and causes some type of organ damage. Normal blood pressure is below 120/80. A person with malignant hypertension has a blood pressure that's typically above 180/120. Malignant hypertension should be treated as a medical emergency.

Myocardial Infarction

is the medical name for a heart attack. A heart attack is a life-threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries.

Atherosclerosis treatment

losing/maintaining healthy weight, lowering serum cholesterol and LDL, min sodium, control comorbidities, stop smoking, app. consistent exercise patterns, oral anticoagulant therapy, surgical interventions (balloons, laser, catheter)at

Types of Hypertension

malignant hypertension,resistant hypertension,pulmonary hypertension,white coat hypertension, and isolated systloic hypertension

Onset & Pathogenesis atherosclerosis

occurs due to an endothelial tissue injury in form of: inflammation, injury to intima, plaque formation, platelet formation, complete obstruction

Thrombophlebitis

presence of a clot [thrombus] plus inflammation in the vein

Types of Angina

stable, unstable, variant

white coat hypertension

your blood pressure is higher when it is taken in a medical setting than it is when taken at home. On average, when your blood pressure is taken at home the top (systolic) number can be around 10mmHg lower than it would be if taken by a doctor and 5mmHg lower on the bottom (diastolic) number. For some people this difference can be even greater.