Acute MyocardialInfarction: also known as a heart attack, happens when adequate bloodflow cannot reach the heart. When blood flow is blocked for a period of time,cell death occurs and damage to the heart muscle results. The most commonsymptom is chest pain. This sensation may be described as squeezing pressureand may run down the left arm. Women sometimes complain of different symptomssuch as shortness of breath, and fatigue.
When a patient presents with chestpain, oxygen will be administered along with nitroglycerin and morphine todecrease pain, promote vasodilation, and decrease the amount of work the heartneeds to do. Once the patient is stable, most likely an EKG will be applied andbloodwork with cardiac enzymes will be drawn. Coronary ArteryDisease: is the blockage of the coronary arteries which supplyoxygenated blood to the heart. As mentioned above, when the artery is blockedseverely, a heart attack can result.
CAD can be diagnosed by a stress test, orcardiac catheterization. If the blockage is significant enough, a stent mayneed to be placed to keep the artery open. Some factors that may contribute toCAD are poor diet or exercise, increased lipids, diabetes, smoking, andhypertension. The patient should be encouraged to make lifestyle changes suchas loose weight, eat healthier, and exercise. Information about keepingdiabetes and high blood pressure under control will also be beneficial. Patientswith CAD will most likely be prescribed nitroglycerin to take if chest painoccurs. Congestive HeartFailure: is diagnosed when the heart muscle is not able to pumpadequately enough to get a sufficient amount of blood to the lungs and the restof the body.
This can be caused by valve problems, damage to the heart muscle,or CAD. When the left ventricle fails, the patient may complain of lethargy orshortness of breath. Symptoms may also include crackles upon auscultation ofthe lungs because the blood that is unable to be ejected to the body backs upinto the lungs. When the right side fails, the blood that cannot be ejectedinto the lungs, backs up into the rest of the body causing edema, weight gain,and enlarged organs.
Right sided failure can be caused if there is an increasein resistance causing the heart to overwork, or if the left side of the hearthas already failed. Patients should be encouraged to make lifestyle changessuch as weight loss and eating healthy to reduce the strain against the heart.Also, medications such as ACE inhibitors, ARBs, and diuretics can also decreasethe workload of the heart. Type I and IIDiabetes Mellitus: Glucose is “food” or energy for your body,especially the central nervous system which thrives solely, on glucose.
Inorder for glucose to go inside cells to be used, insulin must bind to receptorson these cells to make the cells permeable (or open) to glucose. When glucoseis used, the amount of glucose in the blood is lowered. Insulin is made in thepancreas by beta cells. Glucagon is a hormone from the alpha cells of thepancreas which causes stored insulin to be secreted when blood glucose levelsare low. Diabetes occurs when there is a problem with this balance and bloodglucose becomes too high (hyperglycemia) or too low (hypoglycemia). Type Idiabetes is the result of beta cells being destroyed causing a deficiency ofinsulin.
Type II diabetes can be caused from a deficiency of insulin and theinability of the body to use insulin properly to allow glucose into cells.Diabetes can contribute to other health issues such as: cardiovascular disease,vision problems, neuropathy, and increased risk for stroke. All of these issuesare related to the damaging effect the extra glucose has on blood vessels. Themost common symptoms of hyperglycemia include: polyuria (increased urination),polydipsia (excessive thirst), and polyphagia (excessive hunger).
Low bloodglucose can result in dizziness, and changes in mental status. Patients withdiabetes should be well educated about how to manage blood glucose with diet(watching carbohydrates, eating with insulin, etc..), exercise, and insulin (ifapplicable).Hypertension: isanother way of saying high blood pressure. A blood pressure of 120/80 is thedesired measurement. Usually your body uses several different ways to controlblood pressure including: arterial baroreceptors which slow the heart rate andcause vasodilation and increased voiding to decrease excessive fluid volume.When your blood pressure is low, a substance called renin is secreted by thekidneys.
This is eventually converted to an enzyme called angiotensin II whichcauses your blood vessels to constrict, and also causes aldosterone to besecreted. Aldosterone prevents sodium in water from being lost through thekidneys. Therefore, increased aldosterone or renin secretion (such as in kidneydisease) can also cause hypertension. Other causes can be genetics, obesity,alcohol consumption, stress, drugs, and pregnancy. If hypertension is nottreated, it could lead to heart attack or stroke. The patient could reduceblood pressure by avoiding excessive sodium intake, engaging in exercise, andfinding ways to relieve stress. If these methods are not enough to controlhypertension, drugs such as diuretics, calcium channel blockers, and ACEinhibitors may be prescribed.Acute KidneyInjury: or kidney failure happens when there is decreased blood flow tothe kidneys, damage to the kidneys (drugs, infection, cell death), or whenthere is an obstruction of urine.
To identify kidney injury; I/O’s, bloodpressure, and urine appearance should be monitored frequently. Caution shouldespecially be used in patients taking drugs that could be toxic to the kidney’ssuch as NSAIDs, and antibiotics. BUN, electrolytes, and specific gravityabnormalities can also indicate kidney injury. If kidney injury is diagnosed, fluidvolume may increase with IV replacement or be decreased with diuretics, anddialysis may be used to rid the blood of wastes. Kidney function can berestored if the condition is caught and properly treated in time. Chronic KidneyDisease: slowly develops overtime, but is permanent damage that cannot be reversed, only slowed. The mostcommon causes are hypertension or diabetes that are not well controlled. Othercauses may be disease of the tubules, infection, or other diseases of thevascular system, kidneys or urinary tract.
There are five stages of kidneydisease which is determined using a 3 or 24- hour collection of urine toestimate the glomerular filtration rate. During stage one, the patient isconsidered to be at risk for kidney disease. At the second stage (mild), kidneyfunction starts to decrease.
During stage 3 or moderate kidney disease, wastesstart to build up in the blood. By stage 4 (severe) and 5 (end-stage) thekidneys cannot support the body and dialysis is needed. In the later stages,creatinine, BUN, and electrolyte lab levels are increased as the result ofdecreased urine output.
The patient may experience metabolic acidosis becausethe body cannot get rid of enough hydrogen ions which causes the respiratorysystem to try and compensate for this imbalance. Therefore, the patient maybegin to breath deeper and faster. Cardiac changes such as hypertension andheart failure may result because of the extra workload of the heart related toand increase in fluid volume. To treat chronic kidney disease, the patientshould be educated on how to manage the underlying cause (control diabetes orhypertension, etc.). Diuretics and fluid restriction may be used to reduceexcess fluid volume. ACE inhibitors or calcium channel blockers can beprescribed to control blood pressure and slow the disease. Dialysis is alsoused to help rid the body of wastes.
Pneumonia: occurswhen you breath in an organism or substance that causes irritation of yourrespiratory tract. This inflammation causes white blood cells to travel to thelungs to help destroy the infection, which causes fluid build up. Because ofthe fluid, the alveoli cannot expand properly which causes the patient to notget enough oxygen.
The patient may also experience flushing, fever, increasedheart rate, and may produce sputum with coughing. Some complications ofpneumonia are dehydration, sepsis, and collapsed lung. When the lungs areauscultated crackles and possibly wheezing can be heard. If sputum is present,a sample can be cultured to identify what is causing the infection. A chestx-ray is usually ordered to identify the presence of fluid in the lungs.Supplemental oxygen may be given to help resolve hypoxemia and the patientshould be educated on how to use an incentive spirometer.
Bronchodilators,steroids, and anti-infectives may be prescribed to reduce symptoms and resolveinfection. Sepsis: iscaused from an infection that enters the blood stream. Usually when a personhas an infection, it is confined to one part of the body. When the infectionleaves this confinement and enters the blood, systemic inflammatory responsesyndrome takes place. This causes wide spread inflammation and leads tovasodilation. The patient will experience hypotension, decreased cardiacoutput, and an increased respiratory rate.
If the infection progresses, celldeath and organ failure may take place. Septic shock occurs when multipleorgans fail, and bleeding begins because of decreased clot factors. Supplementaloxygen can be given to help reduce hypoxemia, fluids and vasopressors can beused to increase blood pressure, and broad-spectrum antibiotics are given to combatinfection. Blood may also need to be infused if patient experiences hemorrhage.ChronicObstructive Pulmonary Disease: consists of two conditions: emphysemaand chronic bronchitis. In emphysema, the lungs lose their elasticity becauseof an excess of protease.
This reduces the amount of area for gas exchange andcauses some airways to collapse. These changes also cause air to be trapped inthe lungs because the lungs over inflate and over work. The diaphragm muscle isalso weakened by the excessive work of the lungs. The patient may experienceshortness of breath and not completely exhale which causes the build up ofcarbon dioxide and leads to respiratory acidosis.
Chronic bronchitis occurswhen irritants are inhaled. These irritants lead to inflammation which narrowsairways and causes increased production of thick mucus. Risk factors for COPDincluded smoking and asthma. Symptoms include: increased respirations, the useof muscles of the abdomen to breath, shortness of breath with activity, barrel chest,wheezing on auscultation and clubbing of the fingers. Arterial blood gasses,WBC count, and sputum sample can be obtained to monitor gas exchange andidentify infection. Oxygen supplements may be used to reduce hypoxemia. Thepatient can be educated on pursed lip breathing and abdominal breathing.Coughing can also help remove secretions.
Nebulizers and mucolytic medicationscan be prescribed to reduce conditions.PeripheralArterial Disease: occurs when there is blockage in an artery thatdecreases the amount of blood that can flow through. The patient may complainof pain in the leg, back, and feet with activity. Other symptoms include: hairloss on lower extremities, dry skin, cyanosis of the extremities, decreasedpulse, and ulcers of the feet. Angiography can be performed to view blood flowthrough the arteries to detect blockage.
Some non-pharmacologic ways to improveblood flow are: exercise, avoiding tight clothing, keeping extremities warm,and avoiding smoking. The most common drug therapy are drugs that preventcoagulation of blood such as aspirin or clopidogrel. If severe disease ispresent, patients may have to go through arterial revascularization surgery tobypass the blockages. PeripheralVascular Disease: A blood clot can form as the result of an injury,slowness of blood flow, if a patient’s blood clots easily. · Deep VeinThrombosis is a clot that most often develops in the legs, and increasesthe patient’s risk for pulmonary embolism. Symptoms of a DVT usually includeredness and swelling of the leg and pain when flexing the foot. An ultrasoundcan be ordered to view the blood flow in the extremity. A lab test called theD-dimer test can also be drawn to determine if coagulation is present.
Restingthe extremity is usually the most common treatment, the physician may alsorecommend soaking the area in warm water. Compression hose can be worn toincrease blood flow along with elevating the legs. The patient should be toldnot to massage the area; doing so may dislodge the clot. Drug therapy includesanticoagulants such as heparin and warfarin. If non-invasive treatment does notresolve the clot, thrombectomy may be done to remove the clot surgically.· PulmonaryEmbolism is a medical emergency in which a dislodged clot (or any material)travels through the body and lodges in the lungs. This can lead to decreasedperfusion throughout the body and cause death if not resolved quickly.
Riskfactors include: being overweight, recent surgery, and a history of blood clotsor hypercoagulation. Symptoms include trouble breathing, chest pain whenbreathing, coughing, and increased heart rate. Lab tests such as ABG’s andD-dimer test along with a pulmonary angiography can diagnose a pulmonaryembolism. Oxygen supplementation is provided to reduce hypoxemia andanticoagulant therapy (such as heparin) should be started to prevent additionalclotting. If anticoagulant drugs are ineffective or cannot be given anembolectomy will be done to surgically remove the clot. Inferior vena cavafiltration can be performed to place a filter in the vena cava to catch clotsand prevent future pulmonary embolisms. CerebrovascularAccident (Stroke): occurs whenthere is a decrease in blood supply in the brain which can cause tissue deathand lead to disability. Ischemic strokeoccurs when a blood clot is formed in the cerebral artery or is dislodged fromanother part of the body and moves to the brain.
This is usually treated withthrombolytic drugs. An embolectomy or surgical removal of the clot along withstent placement is also an option. Hemorrhagicstroke takes place when bleeding in the brain occurs.
Bleeding canresult from trauma, or rupture of vessels from an aneurysm, arteriovenous malformation,or high blood pressure. Bleeding can occur within the brain tissue itself, orinto the subarachnoid space. Bleedingand edema causes damage to the brain tissue.
When bleeding occurs, the cerebralarteries constrict which lowers blood flow even more and causes additionaldamage. Surgical procedures using resection techniques, clips, and coils can beused to isolate aneurysms and arteriovenous malformations. Risk factors forstrokes include: genetics, atherosclerosis, smoking, obesity, and cocaine use.Symptoms of a stroke include confusion, numbness or drooping of the face,headache, problems talking and understanding others, weakness of one side ofthe body, changes in gait, and visual changes among many other possiblesymptoms.
A CT or MRI is usually performed to identify brain tissue damage orinterruption in blood flow to diagnose a stroke. Thyroid Disease: · Hyperthyroidism:is caused by an overproduction of thyroid hormone. This can be causedby an auto immune disorder called Graves’ disease in which antibodies cause thegland to grow bigger and form a goiter which causes an increase in hormoneproduction. Eye protrusion (exophthalmos) and swelling on the shins (pretibialmyxedema) are also symptoms of Graves’ disease. Toxic multinodular goiter canalso cause hyperthyroidism because of nodule formation on the gland. Thyroidproduction can also be increased if too many replacement thyroid hormones areused. Other symptoms include heat intolerance, vision changes, fatigue,decreased or absence of menstruation,thinning of hair, and tachycardia. T3, T4, and thyroid stimulating hormone labtests can be performed to identify hyperthyroidism.
Thyroid scans or a thyroidultrasound are diagnostic tests that can be ordered to assess the size of the thyroidand the presence of any nodules. The most common drugs prescribed arethionamides and iodine agents to decrease thyroid hormone production andrelease. Surgical removal of the entire thyroid or part of the thyroid may benecessary. If the whole thyroid is removed, the patient will be prescribethyroid hormone replacement. · Hypothyroidismis caused by a decreased level of thyroid hormone and can be caused byif the thyroid is damaged, or if the patient does not take in enough iodide ortyrosine. Symptoms include myxedema (edema caused by mucus), blank facialexpressions, thickening of the tongue, deceased heart and respiratory rate andweight gain. Levothyroxine is the most common drug prescribed for hormonereplacement.
The drug should be taken as prescribed and only changed by thephysician. The dosage is started out low and increased based on TSH levels. Sleep Apnea: occurs when breathing is obstructed whilesleeping for at least 10 seconds. His can be caused by obesity, shortness ofthe neck, tonsils that are enlarged, or edema. Not only does this effectappropriate gas exchange, but waking up frequently prevents adequate rest. Thepatient may report feeling sleeping when awakening and throughout the day andcomplain of waking up several times a night.
This may lead to irritability andlethargy. Family members may report that the patient snores. A sleep study canbe preformed to assess the patient’s respirations and o2 sat while sleeping,along with the amount of sleep they are getting. Losing weight, changingsleeping positions, and removing enlarged tonsils may improve sleep apnea.
Thepatient may also be prescribed a BiPAP or a CPAP at night which will deliverairway pressure through a mask while sleeping to keep airways open.