cardio and hemato ppt
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Cardiologic&
HematologicConditions
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Cardiologic Disorders
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Coronary Atherosclerosis
an abnormal accumulation of lipid, orfatty, substances and fibrous tissue in thevessel wall.
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Angina Pectoris
is a clinical syndromeusually characterized byepisodes or paroxysms of
pain or pressure in theanterior chest. The causeis usually insufficient
coronary blood flow. usually caused by
atherosclerotic disease
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Angina Pectoris
Clinical Manifestations:
- Pain often felt deep in the chest behindthe upper or middle third of the sternum
- the pain or discomfort is poorly localizedand may radiate to the neck, jaw, shoulders,and inner aspects of the upper arms, usuallythe left arm.
- feeling of weakness or numbness in thearms, wrists, and hands may accompany thepain
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Myocardial Infarction
refers to the process bywhich areas of myocardialcells in the heart arepermanently destroyed.
usually caused by reducedblood flow in a coronaryartery due to
atherosclerosis andocclusion of an artery byan embolus or thrombus.
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Myocardial Infarction
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Myocardial Infarction
Clinical Manifestations: Chest pain that occurs suddenly and
continues despite rest and medication
pale, and moist skin
heart rate and respiratory rate may befaster than normal.
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Structural, Infectious and
Inflammatory Cardiac Disorders
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Mitral Valve Prolapse
is a deformity that usually produces no symptoms.
Clinical Manifestations: fatigue, shortness of breath light-headedness dizziness syncope
palpitations, chest pain anxiety
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Mitral Regurgitation
regurgitation involvesblood flowing backfrom the left ventricle
into the left atriumduring systole. Often,the margins of the
mitral valve cannotclose during systole.
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Mitral Regurgitation
Clinical Manifestations:
Dyspnea,
fatigue,
weakness
Palpitations
shortness of breath on exertion
cough from pulmonary congestion alsooccur
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Mitral stenosis
is an obstruction of blood flowing from theleft atrium into the left ventricle. It is mostoften caused by rheumatic endocarditis,
which progressively thickens the mitralvalve leaflets and chordae tendineae. Theleaflets often fuse together. Eventually, the
mitral valve orifice narrows andprogressively obstructs blood flow into theventricle
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Mitral Stenosis
ClinicalManifestations:
dyspnea
fatigue experience
repeated
respiratoryinfections
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Aortic Regurgitation
is the flow of blood back into the leftventricle from the aorta during diastole.
may be caused by inflammatory lesionsthat deform the leaflets of the aortic valve,preventing them from completely closingthe aortic valve orifice.
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Aortic Regurgitation
Clinical Manifestations:
breathing difficulties
exertional dyspnea fatigue
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Aortic Stenosis
is narrowing of the orifice between the leftventricle and the aorta
Clinical Manifestations: exertional dyspnea
dizziness
syncope
Angina Pectoris
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Cardiomyopathies
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Cardiomyopathy
is a heart muscle disease associated withcardiac dysfunction. It is classifiedaccording to the structural and functional
abnormalities of the heart muscle: dilatedcardiomyopathy(DCM), hypertrophiccardiomyopathy (HCM), restrictive orconstrictive cardiomyopathy,
arrhythmogenic right ventricularcardiomyopathy (ARVC), and unclassifiedcardiomyopathy
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Types of Cardiomyopathy
Dilated
Hypertrophic
Restrictive Arrhythmogenic
Right Ventricular
Unclassified
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Types of Cardiomyopathy
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Types of Cardiomyopathy
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Cardiomyopathy
Clinical Manifestations: may remain stable and without symptoms for many years paroxysmal nocturnal dyspnea cough (especially with exertion) orthopnea fluid retention peripheral edema nausea chest pain
palpitations dizziness nausea syncope with exertion
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Congestive Heart Failure
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Congestive Heart Failure
is the inability of the heart to pumpsufficient blood to meet the needs of thetissues for oxygen and nutrients.
indicates myocardial heart disease inwhich there is a problem with contractionof the heart (systolic dysfunction) or fillingof the heart (diastolic dysfunction) and
which may or may not cause pulmonary orsystemic congestion
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Left-sided heart failure
Pulmonary congestion occurs when the left ventriclecannot pump the blood out of the ventricle to the body.The increased left ventricular end-diastolic blood
volume increases the left ventricular end-diastolicpressure, which decreases blood flow from the left
atrium into the left ventricle during diastole.
The blood volume and pressure in the left atriumincreases, which decreases blood flow from thepulmonary vessels. Pulmonary venous blood volumeand pressure rise, forcing fluid from the pulmonarycapillaries into the pulmonary tissues and alveoli,
which impairs gas exchange.
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Left-sided heart failure
Clinical Manifestations:
Dyspnea
Orthopnea Paroxysmal nocturnal dyspnea
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Pathophysiology for Left sided CHF
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Right-sided heart failure
When the right ventricle fails, congestionof the viscera and the peripheral tissuespredominates. This occurs because the
right side of the heart cannot eject bloodand cannot accommodate all the bloodthat normally returns to it from the venous
circulation. The increase in venouspressure leads to jugular vein distention(JVD).
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Right-sided heart failure
Clinical Manifestations: Edema in the lower extremities Hepatomegaly
distended jugular veins ascites (accumulation of fluid in the
peritoneal cavity) weakness
anorexia nausea weight gain due to retention of fluid
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Pathophysiology for Right-sided
CHF
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Acute Heart Failure (PulmonaryEdema)
is the abnormal accumulation of fluid in thelungs. The fluid may accumulate in theinterstitial spaces or in the alveoli.
As the heart fails, pressure in the veins goingthrough the lungs starts to rise.
As the pressure in these blood vesselsincreases, fluid is pushed into the air spaces
(alveoli) in the lungs. This fluid interruptsnormal oxygen movement through the lungs,resulting in shortness of breath.
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Acute Heart Failure (PulmonaryEdema)
Clinical Manifestations: Anxiety and restlessness sudden onset of breathlessness sense of suffocation cold and moist the nail beds become cyanotic (bluish) the skin turns ashen (gray) The pulse is weak and rapid neck veins are distended Incessant coughing with increasing quantities of
mucoid sputum
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Management for CHF
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DIET AND LIFESTYLEMEASURES
First, TREAT LEFT SIDED HEARTFAILURE
Weight reduction through physicalactivity and dietary modification,as obesity is a risk factor for heart failureand left ventricular hypertrophy stopping
smoking avoiding too much alcohol
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DIET AND LIFESTYLEMEASURES
Moderate physical activity, when symptoms aremild or moderate; or bed rest when symptoms aresevere
Monitor weight - this is a parameter that can easilybe measured at home. Rapid weight increase isgenerally due to fluid retention. Weight gain ofmore than 2 pounds is associated with admissionto the hospital for heart failure
Sodium restriction excessive sodium intake mayprecipitate or exacerbate heart failure, thus a "noadded salt" die
MEDICATION/PHARMACOLOGI
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MEDICATION/PHARMACOLOGIC TREATMENT
Diuretics (water pills) mainstay oftherapy and helps reduce fluidaccumulation.
Administer Oxygen
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Nursing Interventions
Place patient at a physical and emotional restto reduce workload of the heart
Elevate head of bed/ place patient in semi-recumbent position to decrease workload ofthe heart, reduce BP, decrease work ofrespiratory muscles and oxygen utilization.
monitor patients blood pressure observe forclinical signs of poor tissue perfusion
elevate lower extremities to reduce edema position patient every 2 hours to help prevent
atelectasis and pneumonia
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Nursing Interventions
encourage deep breathing exercises every 1to 2 hours to avoid atelectasis
offer small, frequent feedings to avoidgastric filling and abdominal distention
administer oxygen
give potassium supplements as prescribed
increase patients activities gradually
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Hematologic Disorders
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AnemiasTYPE Definition
Sickle CellDisease
Is a severe hemolytic anemia that results from inheritance
of the sickle hemoglobin geneClinical Manifestations: anemic (hemoglobin values of 7 to10 g/dL), Jaundice, susceptible to infection, Pale skin ornail beds
G6PD
Deficiency
an inherited disorder characterized by red cells partially or
completely deficient in G6PD, an enzyme critical in aerobicglycolysis. A sex-linked disorder, the defect is fullyexpressed in affected males despite a heterozygous patternof inheritance
Megaloblastic is a blood disorder in which there is anemia with larger-than-normal red blood cells
Iron Deficiency typically results when the intake of dietary iron isinadequate for hemoglobin synthesisClinical manifestations: Extreme fatigue, pale skin,weakness, shortness of breath, irritability, dizziness of
lightheadedness
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Anemias
TYPE CAUSE
Vitamin B12Deficiency
is a low red blood cell count due to a lack of vitamin B12Clinical Manifestations: Diarrhea, constipation, loss ofappetite, pale skin, shortness of breath
Folic AcidDeficiency
happens when your body does not get enough folic acid.
Folic acid is one of the B vitamins, and it helps your bodymake new cells, including new red blood cellsClinical Manifestations: weakness, loss of appetite,lightheadedness,
Aplastic Anemia
Thalassemia Major(Coleys anemia)
is characterized by severe anemia, marked hemolysis, andineffective erythropoiesis (production of RBCs)Clinical Manifestations: Fatigue, pale, weakness,irritability, slow growth, dark urine
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Management for Anemia
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Medical Management
Medications and treatments that correct thecommon underlying causes of anemiainclude the following:
Iron supplements
Vitamin supplements may replace folateand vitamin B12
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Medical Management
epoetin alfa (Procrit or Epogen) injection
Stopping a medication that may be thecause of anemia may also reverse anemia
after consultation with a physician.
If alcohol is the cause of anemia, then inaddition to taking vitamins and
maintaining adequate nutrition, alcoholconsumption needs to be stopped.
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Nursing Management
Managing fatigue assisting patient in prioritizing activities balancing activity and rest periods
Maintaining adequate nutrition encouraging intake of essential nutrients, such as
iron, vitamin B12, folic acid, and protein. avoiding intake of alcohol which may interfere in
the absorption of nutrients providing dietary supplements (iron, vitamin B12,
folic acid)
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Nursing Management
Maintaining adequate perfusion replace lost volume with intravenous fluids or blood
transfusion supplemental oxygen as needed monitoring vital signs and O2 saturations closely
Promoting compliance with prescribed therapy develop ways to incorporate therapeutic plan into activities assist in obtaining needed medications
Monitoring and managing potential compilcations monitor for signs and symptoms of heart failure and
hypersensitivity reactions when transfusing blood products
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Leukemia Group of malignant disorders involving
abnormal overproduction of a specificWBC type Usually at an immature state
In the bone marrow
Literally white blood, is a neoplasticproliferation of one particular cell type(granulocytes, monocytes, lymphocytes, or
megakaryocytes).
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The leukemias are commonly classifiedaccording to the stem cell line involved,
either lymphoid or myeloid:1. Acute Myeloid Leukemia
2.Acute Lymphocytic Leukemia
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Acute Myeloid Leukemia
results from a defect in the hematopoieticstem cell that differentiates into allmyeloid cells: monocytes, granulocytes
(neutrophils, basophils, eosinophils),erythrocytes, and platelets
is the most common nonlymphocytic
leukemia
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Clinical Manifestations:
Fever and infection result fromneutropenia
Weakness and fatigue from anemia
Bleeding tendencies fromthrombocytopenia
Pain from an enlarged liver or spleen
hyperplasia of the gums
bone pain from expansion of marrow
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Acute Lymphocytic Leukemia
results from an uncontrolled proliferationof immature cells (lymphoblasts) derivedfrom the lymphoid stem cell
Clinical Manifestations:
Pain from an enlarged liver or spleen
Bone pain
Headache and vomiting (because ofmeningeal involvement).
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Leukemia
Lab assessment
Decreased H&H
Decreased platelets
Altered WBC (low, normal, elevated: usually20,000 to 100,000
Bone marrow aspiration/biopsy identifies
types
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Leukemia
Drug therapy
Intensive combination chemotherapy
Major side effects: bone marrow depression
Increases vulnerability to infection
Antibiotics, antifungals, antivirals
Bone marrow transplantation (BMT)
Peripheral Blood Stem Cell Transplant(PBSCT)
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Management for Leukemia
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Medical Management
People with leukemia have manytreatment options. The options arewatchful waiting, chemotherapy, targeted
therapy, biological therapy, radiationtherapy, and stem cell transplant.
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Nursing Management
Preventing or managing infection thorough hand hygiene must be performed by
everyone before entering the room allow no one with flu, colds, or infectious
disease to contact the patient use private room for patients having ANC
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Nursing Management
dietary
provide low-microbial diet
encourage adequate hydration
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Nursing Management
Patient
avoid suppositories, enemas, rectaltemperatures
practice deep breathing while awake
ambulate: use mask
prevent dry skin with the use of lubricants
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Nursing Management
Preventing bleeding avoid aspirin and aspirin-containing
medications do not give IM injections avoid indwelling catheters use stool softeners to prevent constipation use smallest possible needles when
performing venipuncture apply pressure to venipuncture site for 5min
or when bleeding has stopped
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Nursing Management
permit no flossing of teeth and commercialmouthwashes
use only soft-bristled toothbrush
lubricate lips with water-soluble lubricant every2hours when awake.
discourage vigorous coughing or blowing of thenose
pad side rails as needed use electric razor for shaving assist in ambulation to prevent injury.
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Hemophilia
Two inherited bleeding disordershemophilia A and hemophilia B
Hemophilia A- is caused by genetic defect
that results in deficient or defective factorVIII;
Hemophilia B- (also called Christmas
disease) stems from a genetic defect thatcauses deficient or defective factor IX
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