Unit VIII Cardiovascular
Terms
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- leading cause of death in U.S.
- Cardiovascular disease
- Arteriosclerosis
-
chronic disease of the arterial system where there is abnormal thickening and hardening of the vessel walls
- most common type of arteriosclerosis
- atherosclerosis
- Atherosclerosis
- local accumulation of lipids and fibrinous tissue within the intima of the artery; progressive process; narrows vessel
- three artery layers
- intima, media, adventitia
- potential causes of initial changes in wall of artery durring development of atherosclerosis
- smoking, hypertension, diabetes, increased LDL, decreased HDL, infection, periodontal disease
- Treatment to prevent thrombus formation in the presence of someone with atherosclerosis
- take one asprin every day
- Non-modifiable risk factors of atherosclerosis
- age, gender, family history, race/ethnic group
- modifiable risk factors of atherosclerosis
-
-elevated serum lipid levels: LDL, VLDL, triglycerides, chylomicrons
-low HDL
-High blood pressure
-Cigarette smoking
-Diabetes mellitus/impaired glucose tolerance
-inflammation, infection
-sedentary lifestlye
-obesity(BMI >30, W/H >8)
-Diet (high fat, sodium, and cholesteral; low fiber)
-Stress (anger/hostility/aggression, personality type) - What does HDL do?
- carries lipids away from arteries and to liver where they can be metabolized
- What is LDL?
- Low density lipid- contain more cholesteral than any other lipid protiens
- What is VLDL
- Very low density lipid- contain both cholesterol and triglycerides
- What are triglycerides?
- fatty acids
- What is the normal (preferred)cholesteral levels
- 140-190
- What is the normal (preferred) triglycerides range?
- 40-190
- What is the preferred HDL levels?
- want it to be greater than 40, (as high as possible)
- What is the normal (preferred) LDL range?
-
below 130
*if history of heart disease- below 100 - What is the value of high blood pressure (hypertension)?
- *systolic- greater than 160
- results of Study -associated with increased risk for atherosclerosis
- increased risk if level of LDL >100, cholesterol >200, Triglycerides >150, and HDL
- effects of athersclerosis (3)
-
1. Arterial occlusion: decreased blood flow, ischemia, infarction
2. Aneurysm formation: Pressure on surrounding structures, occlusion of vessel, rupture
3. combination of 1 and 2 - Signs and symptoms of atherosclerosis
- vary with tissue/organ affected
-
Atherosclerosis
signs and symptoms
Brain - Dizziness, flashing lights, confusion, headache, death
-
Atherosclerosis
signs and symptoms
Heart: - Angina(chest pain), infarction, (MI, heart attack), decreased function, death
-
Atherosclerosis
Signs and Symptoms
Extremities: - Pale, cool, cyanotic; decreased pulses, slow capillary filling, tingling, numbness, claudication; loss of hair growth; necrosis
-
Interventions/ Treatment for Atherosclerosis
*Primary -
Primary prevention: prevent atherosclerosis by decreasing/managing risk factors; identify those at risk; educate about risk and lifestyle changes to alter risk:
-
Interventions/treatment for atherosclerosis
Lifestlye changes: -
-diet(low fat & cholesteral, decease sodium, lose weight)
-exercise
-Stress management
-Control BP
-Control diabetes
-Stop smoking
-Medications may be used to manage BP and diabetes - Hypertension
- consistent elevation of systemic arterial BP; sustained systolic BP of 140mm Hg or greater or a diastolic of 90 mm Hg or greater
- Diagnosis of Hypertension
- based on two or more properly measured(cuff size, arm placement,noise level, activity), seated blood pressure readings taken at two or more office visits.
- Incidence of Hypertension
-
65% of Americans over 60 have hypertension
29% of Americans have prehypertension
1/3 are not adequately controlled - Prevalence of Hypertension
- higher in blacks than whites, men at higher risk than women until age 55, after age 55 women at increased risk
- Hypertension contributes to deaths from:
- heart attack, heart failure, "brain attack", renal damage
- Blood Pressure regulated by:
-
Autonomic nervous system (vasocontriction/dilation)
Endocrine system:catecholemines (epinephrine/norepinephrine)
Cardiovascular: Heart, blood vessels, baroreceptors
Renal: Renin-angiotensin mechanism (renin-angiotensinI-angiotensinII-vasoconstriction) and aldosterone-> increase Na+ and H2O - Types of Hypertension (8)
-
1. Primary (essential, idiopathic)
2. Secondary
3. Isolated Systolic Hypertension(ISH)
4. Refractory
5. Pregnancy-induced (PIH)
6. "White Coat" HPTN
7. Malignant
8. Hypertensive crisis - Primary (essential, idopathic)
- most common (92-95% of hypertension);no known cause, although risk factors have been identified (comb. of genetics and environmental factors)
- Secondary
- 5-8% of cases; associated with an underlying disorder, such as renal disease, endocrine->(increase aldosteronism), vascular (coarctation of aorta), pregnancy-related, drug-related, trauma, oral contraceptives, antihistamines
- Isolated Systolic Hypertension (ISH)
- >140mm Hg systolic, normal diastolic(
- Refractory
- resists treatment
- "White Coat" HPTN
- walking into DR. office and blood pressure goes up but any other time it is normal.
- Malignant
- rapidly progressive; Diasolic increase to 140 can cause cerebral edema
- Hypertensive crisis
- sudden rapid onset, very high, can be life threatening;
-
Risk factors: factors that may promote HPTN
Non-modifiable: - Family History, gender, age, ethnicity
- Modifiable:
-
high dietary intake of calories, sodium, fat
low dietary intake of calcium, potassium, magnesium
high alcohol consumption
obesity,
occupation,
diabetes/glucose intolerance
stress profile
socioeconomic status
smoking
physical activity
- Pathophysiology of Primary
-
unknown cause
interaction of risk factors- increased blood volume, inappropriate autoregulation, too much vasoconstriction, sympathetic overstimulation, water and sodium retention, increased renin, inhibited Na-K transport across cell walls - Pathophysiology of Secondary
- cause identidied as renal, endocrine, CV; treat by correcting cause-(caused by a systemic disease)
- Pathophysiology of ISH (isolated systolic hypertension)
- aortic valve insuffiecency, ventricular septal deficit, elevated thyriod, arteriosclerosis of aorta; treat by correcting cause
- Complecated Hypertension
- sustained primary hypertension that had pathologic effects-> edema
- Hypertension Main treatment
- TREAT BP EVEN IF CANNOT IDENTIFY OR TREAT CAUSE!
- Effects of hypertension
- certain organs affected most-are called target organs; damage to structure and function of their blood vessels leads to ischemia, edema
-
Hypertension
effect on CV system -
-Ischemia heat disease: hypertrophy of heart because it doesnt have to work hard to pump blood against resistance due to high PVR; hypertrophy-> increase demand for blood by heart muscle; heart arteries damaged by hypertension->cannot increase blood supply->ischemia causes angina->can lead to MI, also Heart failure
-Blood vessel damage: can result in aneurysm, dissection of blood vessel wall (layer seperate), rupture artery
-Peripheal Vascular disease: decreased circulation to extremities, claudication (pain in legs due to ischemia) -
Hypertension
Effects on Cerebrovascular system: - transient ischemia of brain (TIA), thrombosis in cerebral circulation, aneurysm, hemmorhage, CVA. Accounts for 1/3 of hypertensive deaths
-
Hypertension
effect on eyes: - retinal damage, vascular sclerosis of vessels, hemorrhage, exudation
- Signs and Symptoms of HPTN (13)
-
-may be none-"Silent Killer"
-headache-tends to be occipital, may be worse in AM
-Lightheaded
-TIA
-Vertigo
-Flushed face
-Spontaneous epistaxis (nosebleed)
-personality changes, "nervous"
-vision changes, blurring, retinal changes
-dyspnea, orthopnea-difficult breathing in certain positions
-leg edema (heart failure)
-chest pain (myocardial ischemia)
-nocturia
- Diagnosis of HPTN based on:
- -based on history, physical exam, diagnostic tests,such as accurate serial BP readings
- Diagnostic test for HPTN
-
Urinalysis
Biochemical blood profile
Renal tests-IVP, serum, creantine(give that kidney effected), BUN
Chest x-ray (cardiac enlargement, pulmonary vessels
Electrocardiogram (ECG)-effect on heart
- Treatment goals for HPTN are:
-
1. control so BP is in normal range
2. Prevent morbidity
3. prevent morality - Treatment starts with:
-
-Lifestyle changes to modify risk factors, than add meds if response inadequate.
-depending on severity of HPTN, may start meds immediately. - Life style changes Treatment for HPTN
-
-weight loss
-moderate alcohol intake
-regular physical activity
-DASH diet
-decrease sodium intake - Meds used for HPTN
-
-diuretics (thiazle, loop, K+ sparing, ect.)-tp decrease blood volume
-beta blockers (adrenergics) to slow heart, decrease CO
-vasodilators to decrease PVR
-comb. of more than 1 class of drug=best contol w/ minimal side effects
- HPTN-Step care with meds:
-
1. diuretic or beta blocker-help decrease vasodilation
2. adrenergic inhibitor with diuretic
3. add ACE inhibitor or vasodilator-inhibit angiotensin
4. add other med. calcium channel blockers -
Stage: Sys: Dias:
Normal
PreHPTN
1
2
- Stage: Sys: Dias: Normal _100
- Nursing Role with HPTN
-
-eduacate
-Bring pressure down
-treat symptoms
-help plan for long term self management
-assist in planning stategies
-identify needs for materials
-follow up - Endocarditis
- Infection of the lining of the heart; infective endocarditis
- Incidence of Endocarditis
- incidence decreasing (due to antibiotics and better diagnostic tests) but still a serious condition/complication
- Endocarditis Risk factors(15)
-
-Can occur in normal heart; more likely with previously damaged valves (rheumatic heart disease, syphilis, mitral valve prolapse, congenital abnormality)
Others: congenital heart problems, cardiac surgery, atificial valves, previous infective endocarditis, male gender, IV drug use, long-term vascular catheters, older person, invasive procedures (surgery, diagnostic tests, oral cavity work) - Endocarditis causative organisms:
-
Most common: Staphylococcus aureus, and Streptococcus viridans
Other organsims: enterococci, viruses, fungi, rickettsia, parasites, MRSA - Endocarditis Signs and Symptoms due to:
-
*vary with degree of valvar dysfunction
Sx and Sx due to:
1. infection
2. inflammation
3. microemboli
4. immune complex deposits -
Endocarditis
Diagnostic tests (8) -
-history and physical
-blood culure: (+), identifies organism
-Erythrocyte Sedimentation Rate (ESR):RBC settling faster than normal=sign of inflammation
-Organ scans: may show emboli(collects at site of infammation then travels elsewhere) in brain, kidney, spleen
-ECG: shows heart damage-altered conduction in heart wall, MI due to emboli, CHF because valve damage interferes with blood flow
-CBC: anemia,luekocytosis (increased WBC)
-Cardiac catheterization: coronary artery condition
-Echocardiogram: heart wall motion, valve action and damage
- Endocarditis Treatment
-
-Prevention BEST:education about risk factors, prophylactic antibiotics(when at risk for getting bacteria in blood)
-Antibiotic therapy based on organism; us. IV antibiotics 1st, then oral; comb. may be used; may need to take antibiotics for 4-6 weeks; monitor w/ blood cultures to see if bacteria eradicated; Dr. follow-up important
-Support and Comfort: antipyetics, rest
-Repair valve damage: risky
-Nursing: patient education re: taking antibiotics, prevention