cardiovascular system

CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM

Understanding the Heart.

Anatomy And Physiology

Normal Anatomy: Microscopic– Consists of Three layers- epicardium, myocardium and

endocardium

– The epicardium covers the outer surface of the heart– The myocardium is the middle muscular layer of the

heart– The endocardium lines the chambers and the valves

– The layer that covers the heart is the PERICARDIUM– There are two parts- parietal and visceral pericardium– The space between the two pericardial layers is the

pericardial space

The Layers of the Heart Wall

Epicardium (visceral pericardium)

– Essential layer of the heart– Coronary arteries are found in this layer

Myocardium– Middle and thickest layer of the heart

(CBQ)– Responsible for contraction of the heart

Endocardium

– Innermost layer of the heart– Lines the inside of the myocardium– Covers the heart valves

Myocardial Cell TypesKinds of Cardiac Cells

Where Found Primary Function

Primary Property

Myocardial cells

Myocardium Contraction and Relaxation

Contractility

Specialized cells of the electrical conduction system

Electrical conduction

system

Generation and conduction of electrical impulses

AutomaticityConductivity

Normal Anatomy: Gross

– The heart is located in the LEFT side of the mediastinum

How the heart works.


- The heart and circulation.

- The heart as a pump.

- Blood supply to the heart - the coronary arteries.

- The heart valves.

- The heart is a muscular pump.

- Circulating blood carries oxygen from the lungs and nutrients from the liver.

The heart also has four chambers- two atria and two ventricles- The Left atrium and the right atrium

- The left ventricle and the right ventricle

The heart chambers are guarded by valves- The atrio-ventricular valves- Tricuspid and bicuspid

- The semi-lunar valves- Pulmonic and aortic valves

The Valves of the Heart

Valve Type Name Location

Atrio-ventricular (AV)

TricuspidSeparates right atrium and right ventricle

Mitral (Bicuspid)Separates left atrium and left ventricle

Semilunar Pulmonic

Between right ventricle and pulmonary artery

Aortic Between left ventricle and aorta

The Heart has Four one-way Valves:- Aortic Valve.

- Mitral Valve.

- Pulmonary Valve.

- Tricuspid Valve.


The Blood supply of the heart comes from the Coronary arteries

- Right coronary artery

- Left coronary artery

The Coronary Arteries

Coronary Artery and its Branches

Portion of Myocardium

Supplied

Portion of Conduction

System Supplied

Right Posterior

descending Right

margin (AV nodal)

Right atrium Inferior wall of

right ventricle ½ anterior

surface of left ventricle

AV node (90% of population)

SA node ( > 55%) Bundle of His

Posterior division of left bundle branch

Left Anterior

descending (LAD)

Circumflex (LCX)

Anterior surface of left ventricle

Left atrium Lateral wall of

left ventricle Part of right

ventricle

AV node (10%) SA node (45%) All bundle

branches

- The heart itself must receive enough oxygenated blood.

- Blood is supplied to the heart through the coronary arteries, two main branches which originate just above the aortic valve.

The venous drainage of the heart

1. Cardiac veins2. Coronary sinus

Cardio physiology- Conduction system

- Cardiac (heart) sounds

- Heart rate and Blood pressure

- Cardiac cycle

The main functions of this system are:- to transport oxygen, hormones and nutrients to the tissues


- and to transport waste products to the lungs and kidneys for excretion

The CONDUCTING SYSTEM OF THE HEARTConsists of the

1. SA node- the pacemaker2. AV node- slowest conduction3. Bundle of His – branches into the Right and the Left

bundle branch4. Purkinje fibers- fastest conduction

The Heart: Physiology1. The intrinsic conduction system causes the heart muscle

to depolarize in one direction2. The rate of depolarization is around 75 beats per minute3. The SA node sets the pace of the conduction4. This electrical activity is recorded by the

Electrocardiogram (ECG)

The Heart sounds1. S1- due to closure of the AV valves2. S2- due to the closure of the semi-lunar valves3. S3- due to increased ventricular filling4. S4- due to forceful atrial contraction

Heart rate- Normal range is 60-100 beats per minute

- Tachycardia is greater than 100 bpm

- Bradycardia is less than 60 bpm

- Sympathetic system INCREASES HR

- Parasympathetic system (Vagus) DECREASES HR (CBQ)

The Heart: Physiology- The amount of blood the heart pumps out in each beat is

called the STROKE VOLUME- When this volume is multiplied by the number of heart

beat in a minute (heart rate), it becomes the CARDIAC OUTPUT

- When the Cardiac Output is multiplied by the Total Peripheral Resistance, it becomes the BLOOD PRESSURE

Blood pressure = Cardiac output X Peripheral resistance

Blood pressure- Control is neural (central and peripheral) and hormonal

- Baroreceptors in the carotid and aorta

- Hormones - ADH, Adrenergic hormones, Aldosterone and ANF

- Blood pressure

- Hormones- ADH, Adrenergic hormones, Aldosterone and ANF ADH increases water retention Aldosterone increases sodium retention and water

retention secondarily Epinephrine and NE increase HR and BP ANP= causes sodium excretion

The Cardiac Cycle:1. Systole: Contraction2. Diastole: Relaxation


The Heart: Physiology- The PRELOAD is the degree of stretching of the heart

muscle when it is filled-up with blood

- The AFTERLOAD is the resistance to which the heart must pump to eject the blood

TerminologyCHRONOTROPIC EFFECT

- Refers to a change in heart rate

- A positive chronotropic effect refers to an increase in heart rate

- A negative chronotropic effect refers to a decrease in heart rate

DROMOTROPIC EFFECT

- Refers to a change in the speed of conduction through the AV junction

- A positive dromotropic effect results in an increase in AV conduction velocity

- A negative dromotropic effect results in a decrease in AV conduction velocity

INOTROPIC EFFECT

- Refers to a change in myocardial contractility

- A postive inotropic effect results in an increase in myocardial contractility

- A negative inotropic effect results in a decrease in myocardial contractility

Vascular System- The vascular system consists of the arteries, veins and

capillaries- The arteries are vessels that carry blood away from the

heart to the periphery- The veins are the vessels that carry blood to the heart

- The capillaries are lined with squamos cells, they connect the veins and arteries

- The lymphatic system also is part of the vascular system and the function of this system is to collect the extravasated fluid from the tissues and returns it to the blood

CARDIOVASCULAR ASSESSMENT

Cardiac History- Interview

- Focused assessment

Cardiac Assessment

1. Health History- Obtain description of present illness and the chief

complaint- Chest pain, SOB, Edema, etc.

- Assess risk factors

2. Physical examination - Vital signs- BP, PP, MAP


- Inspection of the skin

- Inspection of the thorax

- Palpation of the PMI, pulses

- Auscultation of the heart sounds

Surface Anatomy

Auscultation

TRICUSPID VALVE lies behind right half of the sternum; opposite the 4th ICS

right half of the lower end of the body of the sternum

MITRAL VALVE lies behind the left half of the sternum; opposite the 4th costal cartilage

apex beat (5th

ICS LMCL)

PULMONARY VALVE

Lies behind the medial end of the 3rd left costal cartilage & the adjoining part of the sternum

Medial end of the 2nd left ICS

AORTIC VALVE Behind left half of sternum; opposite 3rd ICS

Medial end of the 2nd right ICS

3. Laboratory and diagnostic studies- CBC

- Cardiac catheterization

- Lipid profile

- arteriography

- Cardiac enzymes and proteins

- CXR

- CVP

- ECG

- Holter monitoring

- Exercise ECG

Laboratory Test Rationale- To assist in diagnosing MI

- To identify abnormalities

- To assess inflammation

- To determine baseline value

- To monitor serum level of medications

- To assess the effects of medications

CK- MB (creatine kinase) - Indicates myocardial damage

- Elevates in MI within 4-6 hours

- peaks in 18 hours and then declines till 3 days

- 0-5% of total CK (26-174U/L)

- Normal value is 0-7 U/L

Lactate Dehydrogenase (LDH)- Elevates in MI in 24 hours

- peaks in 48-72 hours

- Normally LDH1 is greater than LDH2

- MI- LDH2 greater than LDH1 (flipped LDH pattern)

- Normal value is 70-200 IU/L

Myoglobin- Oxygen binding protein

- Found in both skeletal and cardiac

- Level rises 1 hour after cell death

- Peaks in 4-6 hours


- Returns to normal w/in 24-36 hours

- Not used alone

- Muscular and RENAL disease can have elevated myoglobin

Troponin I and T- Troponin I has a high affinity for myocardial injury

- Elevates within 3-4 hours, peaks in 4-24 hours and persists for 7 days to 3 weeks!

- Troponin I - <0.6 ng/mL

- Troponin T – 0-0.2ng/mL

- REMEMBER to AVOID IM injections before obtaining blood sample!

- Early and late diagnosis can be made!

SERUM LIPIDS- Lipid profile measures the serum cholesterol, triglycerides

and lipoprotein levels- Cholesterol= 200 mg/dL

- Triglycerides- 40- 150 mg/dL

- LDL- 130 mg/dL

- HDL- 30-70- mg/dL

- NPO post midnight (usually 12 hours)

ELECTROCARDIOGRAM (ECG)- A non-invasive procedure that evaluates the electrical

activity of the heart- Electrodes and wires are attached to the patient

- Tell the patient that there is no risk of electrocution

- Avoid muscular contraction/movement

Holter Monitoring- A non-invasive test in which the client wears a Holter

monitor and an ECG tracing recorded continuously over a period of 24 hours

- Instruct the client to resume normal activities and maintain a diary of activities and any symptoms that may develop

Echocardiogram– Non-invasive test that studies the structural and functional

changes of the heart with the use of ultrasound– No special preparation is needed

Stress Test


– A non-invasive test that studies the heart during activity and detects and evaluates CAD

– Exercise test, pharmacologic test and emotional test– Treadmill testing is the most commonly used stress test– Used to determine CAD, Chest pain causes, drug effects

and dysrhythmias in exercise– Pre-test: consent may be required, adequate rest , eat a

light meal or fast for 4 hours and avoid smoking, alcohol and caffeine

– Post-test: instruct client to notify the physician if any chest pain, dizziness or shortness of breath

– Instruct client to avoid taking a hot shower for 10-12 hours after the test

– Pharmacological stress testUse of dipyridamoleMaximally dilates coronary arterySide-effect: flushing of facePre-test: 4 hours fasting, avoid alcohol, caffeinePost test: report symptoms of chest pain

Cardiac Catheterization– Insertion of a catheter into the heart and surrounding

vessels– Obtains information about the structure and performance

of the heart valves and surrounding vessels– Used to diagnose CAD, assess coronary artery patency and

determine extent of atherosclerosis

PRE PROCEDUREEnsure Consentassess for allergy to seafood and iodineWithhold solid food 6-8 hours and liquids for 4 hoursdocument weight and height, baseline VS, blood tests

and document the peripheral pulses inform client that a local anesthetic will be administered

before insertionClient may feel fatigued because of the need to lie for 2

hoursPrepare IV line if prescribedPrepare insertion site by shaving and cleaning with an

antiseptic solution if prescribedAdminister pre medication

INTRATEST inform patient of a fluttery feeling as the catheter

passes through the heart inform the patient that a feeling of warmth and metallic

taste may occur when dye is administered.

POST TESTMonitor VS and cardiac rhythmMonitor dysrrhytmia and chest painMonitor peripheral pulses, color and warmth and

sensation of the extremity distal to insertion site Apply sandbag or compression device to insertion site if

required to maintain pressureMaintain strict bed rest for 6-12 hoursClient may turn from side to side but bed should not be

elevated more than 15 degrees Notify physician if client complains of tingling, cool, pale,

cyanosis and loss of peripheral pulsesKeep the leg straight to prevent occlusion Monitor for bleeding and hematoma formationEncourage fluid intake to flush out the dye Immobilize the arm if the antecubital vein is usedMonitor for dye allergy

Encourage fluid intake to promote renal excretion of dyeMonitor nausea, vomiting, rash and other sign of HPS

rxn

CVP– The CVP is the pressure within the SVC– Reflects the pressure under which blood is returned to the

SVC and right atrium– is measured with a central venous line in the SVC and

balloon flotation catheter in the pulmonary artery– Normal CVP is 3 to 8 mmHg/ 4-10 cm H2O

Increased CVP1. increase in blood volume as a result of Na and water

retention, excessive IVF or heart/renal failure

Decreased CVP2. May indicate decrease in circulating blood volume and

may be to hypovolemia, hemorrhage and severe vasodilatation

Measuring CVP1. Position the client supine with bed elevated at 45

degrees (CBQ)2. Position the zero point of the CVP line at the level of the

right atrium. Usually this is at the MAL, 4th ICS 3. Instruct the client to be relaxed and avoid coughing

and straining. note disease that activity that increases intra-thoracic

pressure such as coughing and straining If the client is on the ventilator reading should be

taken at the point of end expiration

Cardiac Implementation1. Assess the cardio-pulmonary status

- VS, BP, Cardiac assessment 2. Enhance cardiac output

- Establish IV line to administer fluids3. Promote gas exchange

- Administer O2

- Position client in SEMI-Fowler’s

- Encourage coughing and deep breathing exercises4. Increase client activity tolerance

- Balance rest and activity periods

- Assist in daily activities

- Provide strict bed rest if indicated


- Soft foods

- Assistance in self-care5. Promote client comfort

- Assess the client’s description of pain and chest discomfort

- Administer medication as prescribed Morphine for MI Nitroglycerine for Angina Diuretics to relieve congestion (CHF)

6. Promote adequate sleep7. Prevent infection

- Monitor skin integrity of lower extremities

- Assess skin site for edema, redness and warmth

- Monitor for fever

- Change position frequently

8. Minimize patient anxietyEncourage verbalization of feelings, fears and concernsAnswer client questions. Provide information about procedures and medications

Activity Intolerance Monitor TPR and BP Space activities in the

day Permit rest periods

before activity Limit activity 1 hour

before meals Teach energy

conservation measures like bed rest

Edema Instruct patient to avoid constricting garments

Instruct to elevate edematous areas

Instruct patient to avoid dependent positions

Teach patient to prepare low sodium meals

Apply anti-embolic stockings

Pain Instruct patient to stop activity when pain occurs

Administer nitroglycerine for angina

Pace activities within patient’s limits

Instruct patient to avoid cold temperatures and smoking

Instruct to report unrelieved pain immediately

Cardiac Diseases Coronary Artery Disease Myocardial Infarction Congestive Heart Failure

Infective Endocarditis Cardiac Tamponade Cardiogenic Shock

Vascular Diseases Hypertension Buerger’s disease Aneurysm Varicose veins Deep vein thrombosis

Coronary Artery Disease (CAD)- results from the focal narrowing of the large and medium-

sized coronary arteries due to deposition of atheromatous plaque in the vessel wall

Risk Factors1. Age above 45/55 and Sex- Males and post-menopausal

females2. Family History

3. Hypertension

4. DM

5. Smoking

6. Obesity

7. Sedentary lifestyle

8. Hyperlipedimia

Most important MODIFIABLE factors:- Smoking

- Hypertension

- Diabetes

- Cholesterol abnormalities

CAD: Pathophysiology

- Fatty streak formation in the vascular intima

- ↓- T-cells and monocytes ingest lipids in the area of

deposition- ↓

- Atheroma

- ↓- narrowing of the arterial lumen

- ↓- reduced coronary blood flow

- ↓- myocardial ischemia

Pathophysiology- There is decreased perfusion of myocardial tissue and

inadequate myocardial oxygen supply- If 50% of the left coronary arterial lumen is reduced or

75% of the other coronary artery, this becomes significant- Potential for Thrombosis and embolism

Artery walls have three layers.1. The inner layer provides a slippery surface.

2. The middle layer is strong, elastic and muscular.

3. The outer, fibrous, layer adds strength and contains tiny blood vessels that supply blood to the arteries themselves.


Narrowing or obstruction of the coronary arteries is the main cause of a group of disorders known as ischaemic heart disease.

Coronary Artery Disease.- Acute Coronary Syndrome (ACS) is the phrase used

when referring to any cardiac condition involving the coronary arteries.

- Angina is a feeling of tightness or pain across the chest that may spread outwards to the shoulders, upper arms and back. May occur with exercise or strong emotion and can be worse after a meal or in cold weather. Symptoms usually disappear after 1-2 minutes rest.

- Heart attack (myocardial infarction or MI) is when part of the heart muscle dies. This is usually caused by a blood clot (coronary thrombosis), which has blocked one of the coronary arteries supplying the heart and depriving the tissues of oxygen.

Coronary Artery Disease treatment Angioplasty & Stent Coronary Artery Bypass Graft.

- Treatment for C.A.D involves the removal or treatment of risk factors.

- Sometimes procedures to enlarge or bypass coronary artery narrowing are required.

- If Coronary Disease is not treated and the coronary artery becomes blocked the result may be a heart attack.

Angioplasty- Coronary angioplasty involves inserting a balloon into a

diseased (blocked/narrowed) coronary artery through an artery in the groin or arm.

- Commonly a metal support (stent) is inserted into the artery to help keep it open.


A close up of a Stent.

C. A. B. G. - Veins and sometimes arteries are grafted from the aorta to

a point on the coronary artery beyond the area of disease. This enables an adequate blood supply to reach those parts of the heart suffering from ischaemia


Valve Replacements- Aortic Valve Replacement (AVR)

- Mitral Valve Replacement (MVR)

- An Assortment of Replacement Valves

Artificial Valves

Tissue Valves

Mitral Valves

Tricuspid & Bicuspid

Angina Pectoris- Chest pain resulting from coronary atherosclerosis or

myocardial ischemia

Angina Pectoris: Clinical Syndromes

Three Common Types of Angina1. Stable Angina- The typical angina that occurs during exertion,

relieved by rest and drugs and the severity does not change

2. Unstable angina- Occurs unpredictably during exertion and emotion,

severity increases with time and pain may not be relieved by rest and drug

3. Variant angina- Prinzmetal angina, results from coronary artery

VASOSPASMS, may occur at rest

ASSESSMENT FINDINGS1. Chest pain - ANGINA- The most characteristic symptom

- PAIN is described as mild to severe retrosternal pain, squeezing, tightness or burning sensation

- Radiates to the jaw and left arm


- Precipitated by Exercise, Eating heavy meals, Emotions like excitement and anxiety and Extremes of temperature

- Relieved by REST and Nitroglycerin2. Diaphoresis3. Nausea and vomiting4. Cold clammy skin5. Sense of apprehension and doom6. Dizziness and syncope

LABORATORY FINDINGS1. ECG may show normal tracing if patient is pain-free.

Ischemic changes may show ST depression and T wave inversion

2. Cardiac catheterization3. Provides the MOST DEFINITIVE source of diagnosis by

showing the presence of the atherosclerotic lesions- Decreased cardiac output

- Impaired gas exchange

- Activity intolerance

- Anxiety

Nursing Management1. Administer prescribed medications Nitrates- to dilate the venous vessels decreasing

venous return and to some extent dilate the coronary arteries

Aspirin- to prevent thrombus formation Beta-blockers- to reduce BP and HR Calcium-channel blockers- to dilate coronary artery and

reduce vasospasm

2. Teach the patient management of anginal attacks Advise patient to stop all activities Put one nitroglycerin tablet under the tongue Wait for 5 minutes If not relieved, take another tablet and wait for 5

minutes Another tablet can be taken (third tablet) If unrelieved after THREE tablets seek medical

attention

3. Obtain a 12-lead ECG

4. Promote myocardial perfusion Instruct patient to maintain bed rest Administer O2 @ 3 lpm Advise to avoid valsalva maneuvers Provide laxatives or high fiber diet to lessen

constipation Encourage to avoid increased physical activities

5. Assist in possible treatment modalities PTCA- percutaneous transluminal coronary angioplasty To compress the plaque against the vessel wall,

increasing the arterial lumen CABG- coronary artery bypass graft To improve the blood flow to the myocardial tissue

6. Provide information to family members to minimize anxiety and promote family cooperation

7. Assist client to identify risk factors that can be modified8. Refer patient to proper agencies

Myocardial infarction- Death of myocardial tissue in regions of the heart with

abrupt interruption of coronary blood supply


ETIOLOGY and Risk factors1. CAD2. Coronary vasospasm3. Coronary artery occlusion by embolus and thrombus4. Conditions that decrease perfusion- hemorrhage, shock

Risk factors1. Hypercholesterolemia2. Smoking3. Hypertension4. Obesity5. Stress6. Sedentary lifestyle

Pathophysiology- Interrupted coronary blood flow myocardial ischemia

anaerobic myocardial metabolism for several hours myocardial death depressed cardiac function triggers autonomic nervous system response further imbalance of myocardial O2 demand and supply

Assessment Findings1. Chest Pain- Chest pain is described as severe, persistent, crushing

substernal discomfort- Radiates to the neck, arm, jaw and back

- Occurs without cause, primarily early morning

- NOT relieved by rest or nitroglycerin

- Lasts 30 minutes or longer2. Dyspnea3. Diaphoresis4. cold clammy skin5. N/V6. restlessness, sense of doom7. tachycardia or bradycardia8. hypotension9. S3 and dysrhythmias

Laboratory Findings1. ECG- the ST segment is ELEVATED, T wave inversion,

presence of Q wave2. Myocardial enzymes- elevated CK-MB, LDH and

Troponin levels

3. CBC- may show elevated WBC count 4. Test after the acute stage - Exercise tolerance test,

thallium scans, cardiac catheterizationPain- Decreased cardiac output

- Impaired gas exchange

- Activity intolerance

- Altered tissue perfusion

- Constipation

Nursing Intevention1. Provide Oxygen at 2 lpm, Semi-fowler’s2. Administer medications-Morphine to relieve pain

-Nitrates, thrombolytics, aspirin and anticoagulants

- Stool softener and hypolipidemics3. Minimize patient anxiety- Provide information as to procedures and drug therapy

- Allow verbalization of feelings

- Morphine can be administered4. Provide adequate rest periods- Bed rest during acute stage

5. Minimize metabolic demands- Provide soft diet

- Provide a low-sodium, low cholesterol and low fat diet6. Assist in treatment modalities such as PTCA and CABG7. Monitor for complications of MI- especially

dysrhythmias, since ventricular tachycardia can happen in the first few hours after MI

8. Provide client teaching

Medical Management


1. Analgesic- The choice is MORPHINE

- It reduces pain and anxiety

- Relaxes bronchioles to enhance oxygenation2. ACE inhibitors- Prevents formation of angiotensin II

- Limits the area of infarction3. Thrombolytic therapy- Streptokinase, Alteplase

- Dissolve clots in the coronary artery allowing blood to flow

Nursing Interventions After Acute Episode1. Maintain bed rest for the first 3 days2. Provide passive ROM exercises3. Progress with dangling of the feet at side of bed4. Proceed with sitting out of bed, on the chair for 30

minutes TID5. Proceed with ambulation in the room toilet

hallway TID6. Cardiac rehabilitation

- To extend and improve quality of life

- Physical conditioning

- Patients who are able to walk 3-4 mph are usually ready to resume sexual activities

Cardiomyopathies- Heart muscle disease associated with cardiac dysfunction

1. Dilated Cardiomyopathy2. Hypertrophic Cardiomyopathy3. Restrictive cardiomyopathy

Dilated CardiomyopathyAssociated Factors

1. Heavy alcohol intake

2. Pregnancy

3. Viral infection

4. Idiopathic

Pathophysiology Diminished contractile proteins poor contraction

decreased blood ejection increased blood remaining in the ventricle ventricular stretching and dilatation.

Systolic Dysfunction

Hypertrophic CardiomyopathyAssociated factors:

1. Genetic2. Idiopathic

PathophysiologyIncreased size of myocardium reduced ventricular volume increased resistance to ventricular filling diastolic dysfunction

Restrictive CardiomyopathyAssociated factors

1. Infiltrative diseases like AMYLOIDOSIS2. Idiopathic

PathophysiologyRigid ventricular wall impaired stretch and diastolic filling decreased outputDiastolic dysfunction

Assessment findings

1. PND2. Orthopnea3. Edema4. Chest pain5. Palpitations6. Dizziness7. Syncope with exertion

Laboratory Findings CXR- may reveal cardiomegaly Echocardiogram ECG Myocardial Biopsy

Medical Management1. Surgery - heart transplant2. Pacemaker insertion3. Pharmacological drugs for symptom relief

Nursing Management1. Improve cardiac output

- Adequate rest

- Oxygen therapy

- Low sodium diet2. Increase patient tolerance

- Schedule activities with rest periods in between3. Reduce patient anxiety

- Support patient

- Offer information about transplantations

- Support family in anticipatory grieving

Infective endocarditis- Infection of the heart valves and the endothelial surface of

the heartCan be acute, sub-acute or chronic

Etiologic factors1. Bacteria- Organism depends on several factors2. Fungi

Risk factors1. Prosthetic valves

2. Congenital malformation

3. Cardiomyopathy

4. IV drug users

5. Valvular dysfunctions

PathophysiologyDirect invasion of microbes

↓microbes adhere to damaged valve surface and proliferate

↓damage attracts platelets causing clot formation

↓erosion of valvular leaflets and the clot and vegetation can

embolizeAssessment findings

1. Intermittent high grade fever2. anorexia, weight loss3. cough, back pain and joint pain4. splinter hemorrhages under nails5. Osler’s nodes- painful nodules on fingerpads6. Roth’s spots- pale hemorrhages in the retina7. Heart murmurs8. Heart failure= usually acute heart failure

Prevention


- Antibiotic prophylaxis if patient is undergoing procedures like dental extractions, bronchoscopy, surgery, etc.

- Any invasive procedure that is associated with transient bacteremia may cause the microrganism to lodge in the damaged, irregular valves

Laboratory Exam- Blood Cultures to determine the exact organism

Usually, 3 culture specimens are obtained and antibiotic sensitivity done

Nursing management1. Regular monitoring of temperature, heart sounds 2. Manage infection3. Long-term antibiotic therapy is given to ensure

eradication of bacteria

Medical management1. Pharmacotherapy- IV antibiotic for 2-6 weeks

- Antifungal agents are given – amphotericin B2. Surgery3. Valvular replacement

Congestive Heart Failure (CHF)- A syndrome of congestion of both pulmonary and systemic

circulation caused by inadequate cardiac function and inadequate cardiac output to meet the metabolic demands of tissues

- Inability of the heart to pump sufficiently

- The heart is unable to maintain adequate circulation to meet the metabolic needs of the body

This can happen acutely or chronically - Acute in Myocardial infarction

- Chronic cardiomyopathies

Classified according to the major ventricular dysfunction

1. Left Ventricular failure2. Right ventricular failure

Etiology of CHF1. CAD2. Valvular heart diseases

3. Hypertension4. MI5. Cardiomyopathy6. Lung diseases7. Post-partum8. Pericarditis and cardiac tamponade

New York Heart AssociationClass 1

- Ordinary physical activity does NOT cause chest pain and fatigue

- No pulmonary congestion

- Asymptomatic

- NO limitation of ADLs

Class 2- SLIGHT limitation of ADLs

- NO symptom at rest

- Symptoms with INCREASED activity

- Basilar crackles and S3

- New York Heart Association

Class 3- Markedly limitation on ADLs

- Comfortable at rest BUT symptoms present in LESS than ordinary activity

Class 4- SYMPTOMS are present at rest

PATHOPHYSIOLOGYLEFT Ventricular pump failure

↓ back up of blood into the pulmonary veins

↓ increased pulmonary capillary pressure

↓

pulmonary congestion (edema)↓

Pulmonary manifestations

LEFT ventricular failure↓

Decreased cardiac output↓

Decreased perfusion to the brain, kidney and other tissues ↓

Cerebral anoxia, fatigue, oliguria, dizziness

RIGHT ventricular failure↓

blood pooling in the venous circulation ↓

increased hydrostatic pressure↓

peripheral edema↓

RIGHT ventricular failure↓


Venous blood pooling↓

venous congestion in the kidney, liver and GITLeft Sided CHF Assessment Findings

1. Dyspnea on exertion, activity intolerance2. PND3. Orthopnea4. Pulmonary crackles/rales5. Cough with Pinkish, frothy sputum6. Tachycardia7. Cool extremities8. Cyanosis9. decreased peripheral pulses10.Fatigue11.Oliguria12.signs of cerebral anoxia

Right Sided CHF Assessment Findings1. Peripheral dependent, pitting edema2. Weight gain3. Distended neck vein4. hepatomegaly5. Ascites6. Body weakness7. Anorexia, nausea8. Pulsus alternans9. Nocturia= urination at night at frequent intervals as

the blood moves from interstitial space to the intravascular space and is excreted

Laboratory Findings1. CXR may reveal cardiomegaly2. ECG may identify Cardiac hypertrophy3. Echocardiogram may show hypokinetic heart4. ABG and Pulse oximetry may show decreased O2

saturation5. PCWP is increased in LEFT sided CHF and CVP is

increased in RIGHT sided CHF

Nursing Interventions1. Assess patient's cardio-pulmonary status2. Assess VS, CVP and PCWP. Weigh patient daily to

monitor fluid retention3. Administer medications- usually cardiac glycosides are

given- DIGOXIN or DIGITOXIN, Diuretics, vasodilators and hypolipidemics are prescribed

Cardiotonics Positive inotropic agents

To increase cardiac contractility

Diuretics To decrease the intravascular volume in the circulation

Low Sodium Diet To minimize water retentionHypolipidemics To decrease the lipid levels of

high risk patients

Digoxin Health teaching- Oral tablet usually once a day

- Increases force of contraction

- DECREASES heart rate

- Assess: Apical pulse, ECG, hypokalemia

- Withhold the drug if apical pulse is less than 60

- Note for early signs of toxicity: NAVDA

- Provide potassium supplements

4. Provide a LOW sodium diet. Limit fluid intake as necessary

5. Provide adequate rest periods to prevent fatigue

6. Position on semi-fowler’s to fowler’s for adequate chest expansion

7. Prevent complications of immobility

Nursing Intervention after the Acute Stage1. Provide opportunities for verbalization of feelings2. Instruct the patient about the medication regimen-

digitalis, vasodilators and diuretics3. Instruct to avoid OTC drugs, Stimulants, smoking and

alcohol4. Provide a LOW fat and LOW sodium diet5. Provide potassium supplements6. Instruct about fluid restriction7. Provide adequate rest periods and schedule activities8. Monitor daily weight and report signs of fluid retention

Cardiogenic Shock- Heart fails to pump adequately resulting to a

decreased cardiac output and decreased tissue perfusion

Etiology1. Massive MI2. Severe CHF3. Cardiomyopathy4. Cardiac trauma5. Cardiac tamponade

Assessment Findings1. HYPOTENSION 2. Oliguria (less than 30 ml/hour) 3. Tachycardia 4. Narrow pulse pressure 5. weak peripheral pulses6. cold clammy skin7. changes in sensorium/LOC8. pulmonary congestion

Laboratory Findings- Increased CVP due to pooling of blood in the venous

systemNormal is 4-10 cmH2O

- Metabolic acidosis

Nursing Interventions1. Place patient in a modified Trendelenburg (shock )

position2. Administer IVF, vasopressors and inotropics such as

DOPAMINE and DOBUTAMINE3. Administer O24. Morphine is administered to decreased pulmonary

congestion and to relieve pain, relieve anxiety5. Assist in intubation, mechanical ventilation, PTCA,

CABG, insertion of Swan-Ganz cath and IABP6. Monitor urinary output, BP and pulses7. Cautiously administer diuretics and nitrates

CARDIAC TAMPONADE- A condition where the heart is unable to pump blood due

to accumulation of fluid in the pericardial sac (pericardial effusion)

- This condition restricts ventricular filling resulting to decreased cardiac output

- Acute tamponade may happen when there is a sudden accumulation of more than 50 ml fluid in the pericardial sac

Causative factors1. Cardiac trauma2. Complication of Myocardial infarction3. Pericarditis4. Cancer metastasis


Assessment Findings1. BECK’s Triad- Jugular vein distention, hypotension and

distant/muffled heart sound2. Pulsus paradoxus3. Increased CVP4. decreased cardiac output5. Syncope6. anxiety7. dyspnea 8. Percussion- Flatness across the anterior chest

Laboratory Findings1. Echocardiogram= shows accumulate fluid in the

pericardial sac 2. Chest X-ray

Nursing Interventions1. Assist in PERICARDIOCENTESIS2. Administer IVF3. Monitor ECG, urine output and BP4. Monitor for recurrence of tamponade

Pericardiocentesis- Patient is monitored by ECG

- Maintain emergency equipments

- Elevate head of bed 45-60 degrees

- Monitor for complications- coronary artery rupture, dysrhythmias, pleural laceration and myocardial trauma

Vascular Diseases

General Measures to Improve Peripheral Circulation1. Implement Regular Physical Activity – to facilitate

movement of venous blood2. Eliminate cigarette smoking- to prevent vasoconstriction3. Control hyperlipidemia and cholesterol levels- to prevent

the progression of atherosclerosis4. Avoid cold environmental temperature5. Teach clients to assess fingers and toes daily for

circulatory adequacy: Check the peripheral pulses, capillary refill and temp

6. Report break in the skin

Hypertension- A systolic BP greater than 140 mmHg and a diastolic

pressure greater than 90 mmHg over a sustained period, based on two or more BP measurements.

Types of Hypertension1. Primary or Essential

- Most common type2. Secondary - Due to other conditions like Pheochromocytoma,

renovascular hypertension, Cushing’s, Conn’s , SIADH

Classification Of Hypertension By Jnc-Vii

Pathophysiology- Multi-factorial etiology

o BP= CO (SV X HR) x TPRAny increase in the above parameters will increase BP

Risk factors for Cardiovascular Problems in Hypertensive patientsMajor Risk factors

1. Smoking2. Hyperlipidemia3. DM4. Age older than 60 5. Gender- Male and post menopausal women6. Family History

Any increase in the above parameters will increase BP1. Increased sympathetic activity2. Increased absorption of Sodium, and water in the

kidney3. Increased activity of the RAAS


4. Increased vasoconstriction of the peripheral vessels5. Insulin resistance

Assessment Findings1. Headache2. Visual changes3. chest pain4. dizziness5. N/V

Diagnostic Studies1. Health history and PE2. Routine laboratory- urinalysis, ECG, lipid profile, BUN,

serum creatinine , FBS3. Other lab- CXR, creatinine clearance, 24-huour urine

protein

Medical Management1. Lifestyle modification2. Diet therapy3. Drug therapy

MEDICAL MANAGEMENTDrug therapy

- Diuretics

- Beta blockers

- Calcium channel blockers

- ACE inhibitors

- A2 Receptor blockers

- VasodilatorsNursing Interventions

1. Provide health teaching to patient- Teach about the disease process

- Elaborate on lifestyle changes

- Assist in meal planning to lose weight

- Provide list of LOW fat , LOW sodium diet of less than 2-3 grams of Na/day

- Limit alcohol intake to 30 ml/day

- Regular aerobic exercise

- Advise to completely Stop smoking

2. Provide information about anti-hypertensive drugs- Instruct proper compliance and not abrupt cessation of

drugs even if pt becomes asymptomatic/ improved condition

- Instruct to avoid over-the-counter drugs that may interfere with the current medication

3. Promote Home care management- Instruct regular monitoring of BP

- Involve family members in care

- Instruct regular follow-up4. Manage hypertensive emergency and urgency properly

Aneurysm- Dilation involving an artery formed at a weak point in the

vessel wall- Saccular= when one side of the vessel is affected

- Fusiform= when the entire segment becomes dilated

Risk Factors1. Atherosclerosis2. Infection= syphilis3. Connective tissue disorder4. Genetic disorder= Marfan’s Syndrome

Pathophysiology

- Damage to the intima and media weakness outpouching of vessel wall

- Dissecting aneurysm tear in the intima and media with dissection of blood through the layers

Assessment1. Asymptomatic2. Pulsatile sensation on the abdomen3. Palpable bruit

Laboratory:- CT scan

- Ultrasound

- X-ray

- Aortography

Medical Management:- Anti-hypertensives

- Synthetic graft

Nursing Management:- Administer medications

- Emphasize the need to avoid increased abdominal pressure

- No deep abdominal palpation

- Remind patient the need for serial ultrasound to detect diameter changes.

Peripheral Arterial Occlusive Disease- Refers to arterial insufficiency of the extremities usually

secondary to peripheral atherosclerosis.- Usually found in males age 50 and above

- The legs are most often affected

Risk factors for Peripheral Arterial occlusive diseaseNon-Modifiable

1. Age2. gender3. family predisposition

Modifiable1. Smoking 2. HPN3. Obesity4. Sedentary lifestyle5. DM6. Stress

Assessment Findings1. INTERMITTENT CLAUDICATION- the hallmark of PAOD- This is PAIN described as aching, cramping or fatiguing

discomfort consistently reproduced with the same degree of exercise or activity

- This pain is RELIEVED by REST

- This commonly affects the muscle group below the arterial occlusion

2. Progressive pain on the extremity as the disease advances

3. Sensation of cold and numbness of the extremities4. Skin is pale when elevated and cyanotic and ruddy

when placed on a dependent position5. Muscle atrophy, leg ulceration and gangrene

Diagnostic Findings1. Unequal pulses between the extremities2. Duplex ultrasonography3. Doppler flow studies

Medical Management1. Drug therapy


- Pentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles

- Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation

2. Surgery- Bypass graft and anastomoses

Nursing Interventions1. Maintain Circulation to the extremity- Evaluate regularly peripheral pulses, temperature,

sensation, motor function and capillary refill time- Administer post-operative care to patient who

underwent surgery- Administer heat modalities to the leg cautiously to

promote vasodilatation

2. Monitor and manage complications- Note for bleeding, hematoma, and decreased urine

output- Elevate the legs to diminish edema

- Encourage exercise of the extremity while on bed

- Teach patient to avoid leg-crossing

3. Promote Home management- Encourage lifestyle changes

- Instruct to AVOID smoking

- Instruct to avoid leg crossing

BUERGER’S DISEASEThromboangiitis obliterans

- A disease characterized by recurring inflammation of the medium and small arteries and veins of the lower extremities

- Occurs in MEN ages 20-35

- RISK FACTOR: SMOKING!

Pathophysiology- Cause is UNKNOWN

- Probably an Autoimmune disease

- Inflammation of the arteries and veins thrombus formation occlusion of the vessels

Assessment Findings1. Leg PAIN- Foot cramps in the arch

- (INSTEP CLAUDICATION) after exercise

- Relieved by rest

- Aggravated by smoking, emotional disturbance and cold chilling

2. Digital rest pain not changed by activity or rest3. Intense RUBOR (reddish-blue discoloration), progresses

to CYANOSIS as disease advances4. Paresthesias

Diagnostic Studies1. Duplex ultrasonography2. Contrast angiography

Nursing Interventions1. Assist in the medical and surgical management- Bypass graft

- amputation2. Strongly advise to AVOID smoking3. Manage complications appropriately

Post-operative care: after amputation- Elevate stump for the FIRST 24 HOURS to minimize

edema and promote venous return- Place patient on PRONE position after 24 hours several

times a day- Assess skin for bleeding and hematoma

- Wrap the extremity with elastic bandageRaynaud’s Disease

- A form of intermittent arteriolar VASOCONSTRICTION that results in coldness, pain and pallor of the fingertips or toes

- Cause : UNKNOWN

- Most commonly affects WOMEN, 16- 40 years old

Assessment Findings1. Raynaud’s phenomenon- A localized episode of vasoconstriction of the small

arteries of the hands and feet that causes color and temperature changes

W-B-R is the acronym for the color change- Pallor- due to vasoconstriction, then - Blue- due to pooling of Deoxygenated blood

- Red- due to exaggerated reflow or hyperemia2. Tingling sensation3. Burning pain on the hands and feet

Medical management- Drug therapy with the use of CALCIUM channel blockers

To prevent vasospasms

Nursing Interventions1. Instruct patient to avoid situations that may be

stressful2. Instruct to avoid exposure to cold and remain indoors

when the climate is cold3. Instruct to avoid all kinds of nicotine4. Instruct about safety. Careful handling of sharp objects

Venous diseases


Varicose Veins- THESE are dilated veins usually in the lower extremities

Predisposing Factors Pregnancy Prolonged standing or sitting Incompetent venous valves

PathophysiologyFactors venous stasis increased hydrostatic pressure edema

Assessment findings- Tortuous superficial veins on the legs

- Leg pain and Heaviness

- Dependent edema

Laboratory findings- Venography

- Duplex scan pletysmography

Medical management- Pharmacological therapy

- Leg vein stripping and ligation

- Anti-embolic stockings

Nursing management1. Advise patient to elevate the legs with pillow to

increase venous return2. Caution patient to avoid prolonged standing or sitting3. Provide high-fiber foods to prevent constipation4. Teach simple exercise to promote venous return5. Caution patient to avoid constrictive clothing6. Apply anti-embolic stockings as directed7. Avoid massage on the affected area

DVT- Deep Vein Thrombosis- Inflammation of the deep veins of the lower extremities

and the pelvic veins- The inflammation results to formation of blood clots in the

areaPredisposing factors- Prolonged immobility

- Varicosities

- Traumatic procedures

- Increased age

- Malignancy

- Estrogen therapy

- SmokingComplication- PULMONARY thromboembolism

Assessment findings- Leg tenderness

- Leg pain and edema

- Positive HOMAN’s SIGNHOMAN’s SIGNThe foot is FLEXED upward (dorsiflexed) , there is a sharp pain felt in the calf of the leg indicative of venous inflammation

Laboratory findings- Venography

- Duplex scan

Medical management- Antiplatelets- aspirin

- Anticoagulants

- Vein stripping and grafting

- Anti-embolic stockings

Nursing management1. Provide measures to avoid prolonged immobility- Repositioning Q2

- Provide passive ROM

- Early ambulation2. Provide skin care to prevent the complication of leg

ulcers3. Provide anti-embolic stockings4. Administer anticoagulants as prescribed5. Monitor for signs of pulmonary embolism sudden

respiratory distress

Blood disorders Anemia Nutritional anemia Hemolytic anemia Aplastic anemia Sickle cell anemia

Anemia- A condition in which the hemoglobin concentration is lower

than normal

Three broad categories1. Loss of RBC- occurs with bleeding2. Decreased RBC production3. Increased RBC destruction

Hypoproliferative Anemia


Iron Deficiency Anemia- Results when the dietary intake of iron is inadequate to

produce hemoglobinEtiologic Factors1. Bleeding- the most common cause2. Mal-absorption3. Malnutrition4. Alcoholism

Pathophysiology- The body stores of iron decrease, leading to depletion

of hemoglobin synthesis- The oxygen carrying capacity of hemoglobin is

reduced tissue hypoxia

Assessment Findings1. Pallor of the skin and mucous membrane2. Weakness and fatigue3. General malaise4. Pica5. Brittle nails6. Smooth and sore tongue7. Angular cheilosis

Laboratory findings1. CBC- Low levels of Hct, Hgb and RBC count2. Low serum iron, low ferritin3. Bone marrow aspiration- MOST definitive

Medical management1. Hematinics2. Blood transfusion

Nursing Management1. Provide iron rich-foods- Organ meats (liver)

- Beans

- Leafy green vegetables

- Raisins and molasses

2. Administer iron - Oral preparations tablets- Fe fumarate, sulfate and

gluconate- Advise to take iron ONE hour before meals

- Take it with vitamin C

- Continue taking it for several months

- Oral preparations- liquid

- It stains teeth

- Drink it with a straw

- Stool may turn blackish- dark in color

- Advise to eat high-fiber diet to counteract constipation

- IM preparation

- Administer DEEP IM using the Z-track method

- Avoid vigorous rubbing

- Can cause local pain and staining

Aplastic Anemia- A condition characterized by decreased number of RBC

as well as WBC and platelets

Causative Factors1. Environmental toxins- pesticides, benzene2. Certain drugs- Chemotherapeutic agents,

chloramphenicol, phenothiazines, Sulfonamides

3. Heavy metals4. Radiation

PathophysiologyToxins cause a direct bone marrow depression

↓Acellular bone marrow

↓decreased production of blood elements

PANCYTOPENIA

Assessment Findings- fatigue

- pallor

- dyspnea

- bruising

- splenomegaly

- retinal hemorrhages

Laboratory Findings1. CBC- decreased blood cell numbers2. Bone marrow aspiration confirms the anemia-

hypoplastic or acellular marrow replaced by fats

Medical Management1. Bone marrow transplantation2. Immunosupressant drugs3. Rarely, steroids4. Blood transfusion

Nursing management1. Assess for signs of bleeding and infection2. Instruct to avoid exposure to offending agents

Megaloblastic Anemias- Anemias characterized by abnormally large RBC

secondary to impaired DNA synthesis due to deficiency of Folic acid and/or vitamin B12

Folic Acid deficiencyCausative factors1. Alcoholism2. Mal-absorption3. Diet deficient in uncooked vegetables

Pathophysiology of Folic acid deficiencyDecreased folic acid

↓impaired DNA synthesis in the bone marrow

↓Impaired RBC development, impaired nuclear maturation but

CYTOplasmic maturation continues↓

large size

Vitamin B12 deficiencyCausative factors

1. Strict vegetarian diet2. Gastrointestinal mal-absorption3. Crohn's disease4. Gastrectomy

Vitamin B12 deficiency: Pernicious Anemia- Due to the absence of intrinsic factor secreted by

the parietal cells - Intrinsic factor binds with Vit. B12 to promote

absorption

Assessment findings1. weakness2. fatigue3. listless


4. neurologic manifestations are present only in Vit. B12 deficiency

Assessment findingsPernicious Anemia- Beefy, red, swollen tongue

- Mild diarrhea

- Extreme pallor

- Paresthesias in the extremities

Laboratory findings1. Peripheral blood smear- shows giant RBCs, WBCs

with giant hyper-segmented nuclei2. Very high MCV3. Schilling’s test4. Intrinsic factor antibody test

Medical Management1. Vitamin supplementation2. Folic acid 1 mg daily3. Diet supplementation4. Vegetarians should have vitamin intake5. Lifetime monthly injection of IM Vit B12

Nursing Management1. Monitor patient2. Provide assistance in ambulation3. Oral care for tongue sore4. Explain the need for lifetime IM injection of vit B12

Hemolytic Anemia: Sickle Cell- A severe chronic incurable hemolytic anemia that

results from heritance of the sickle hemoglobin gene.Causative factor- Genetic inheritance of the sickle gene- HbS genePathophysiology

Decreased O2, Cold, Vasoconstriction can precipitate sickling processFactors cause defective hemoglobin to acquire a rigid, crystal-like C-shaped configuration Sickled RBCs will adhere to endothelium pile up and plug the vessels ischemia results pain, swelling and fever

Assessment Findings1. jaundice (hemolytic jaundice)2. enlarged skull and facial bones3. tachycardia, murmurs and cardiomegaly- Primary sites of thrombotic occlusion: spleen, lungs

and CNS- Chest pain, dyspnea

Assessment Findings1. Sickle cell crises

- Results from tissue hypoxia and necrosis2. Acute chest syndrome

- Manifested by a rapidly falling hemoglobin level, tachycardia, fever and chest infiltrates in the CXR

Medical Management1. Bone marrow transplant2. Hydroxyurea3. Increases the HbF4. Long term RBC transfusion

Nursing Management

1. manage the painSupport and elevate acutely inflamed jointRelaxation techniquesanalgesics

2. Prevent and manage infectionMonitor status of patientInitiate prompt antibiotic therapy

3. Promote coping skills- Provide accurate information

- Allow patient to verbalize her concerns about medication, prognosis and future pregnancy

4. Monitor and prevent potential complications- Provide always adequate hydration

- Avoid cold, temperature that may cause vasoconstriction

- Leg ulcer Aseptic technique

- Priapism Sudden painful erection Instruct patient to empty bladder, then take a

warm bath

Polycythemia Refers to an INCREASE volume of RBCs The hematocrit is ELEVATED to more than 55% Classified as Primary or Secondary

Primary Polycythemia- A proliferative disorder in which the myeloid stem

cells become uncontrolled

Causative factor- unknown

Pathophysiology- The stem cells grow uncontrollably

- The bone marrow becomes HYPERcellular and all the blood cells are increased in number

- The spleen resumes its function of hematopoiesis and enlarges

- Blood becomes thick and viscous causing sluggish circulation

- Overtime, the bone marrow becomes fibrotic

Assessment findings- Skin is ruddy

- Splenomegaly

- headache

- dizziness, blurred vision

- Angina, dyspnea and thrombophlebitis

Laboratory findings1. CBC- shows elevated RBC mass2. Normal oxygen saturation3. Elevated WBC and Platelets

Complications1. Increased risk for thrombophlebitis, CVA and MI2. Bleeding due to dysfunctional blood cells

Medical Management1. To reduce the high blood cell mass- PHLEBOTOMY

2. Allopurinol

3. Dipyridamole

4. Chemotherapy to suppress bone marrow

Nursing Management


1. Primary role of the nurse is EDUCATOR2. Regularly asses for the development of

complications3. Assist in weekly phlebotomy4. Advise to avoid alcohol and aspirin5. Advise tepid sponge bath or cool water to manage

pruritus

Leukemia- Malignant disorders of blood forming cells

characterized by UNCONTROLLED proliferation of WHITE BLOOD CELLS in the bone marrow- replacing marrow elements .

- The WBC can also proliferate in the liver, spleen and lymph nodes.

- The leukemias are named after the specific lines of blood cells afffected primarily Myeloid Lymphoid Monocytic

- The leukemias are named also according to the maturation of cells- ACUTE

The cells are primarily immature- CHRONIC

The cells are primarily mature or differentiated- ACUTE myelocytic leukemia

- ACUTE lymphocytic leukemia

- CHRONIC myelocytic leukemia

- CHRONIC lymphocytic leukemia

Etiologic Factors- UNKNOWN

- Probably exposure to radiation

- Chemical agents

- Infectious agents

- Genetic

Pathophysiology of ACUTE Leukemia- Uncontrolled proliferation of immature cells

suppresses bone marrow function severe anemia, thrombocytopenia and granulocytopenia

- Uncontrolled proliferation of DIFFERENTIATED cells slow suppression of bone marrow function milder symptoms

Assessment FindingsAcute Leukemia- Pallor

- Fatigue

- Dyspnea

- Hemorrhages

- Organomegaly

- Headache

- vomiting

- Leukemia

Chronic Leukemia- Less severe symptoms

- Organomegaly

- Leukemia

Laboratory Findings- Peripheral WBC count varies widely

- Bone marrow aspiration biopsy reveals a large percentage of immature cells- BLASTS

- Erythrocytes and platelets are decreased

Medical Management1. Chemotherapy2. Bone marrow transplantation

Nursing Management1. Manage AND prevent infection

- Monitor temperature

- Assess for signs of infection

- Be alert if the neutrophil count drops below 1,000 cells/mm3

2. Maintain skin integrity3. Provide pain relief4. Provide information as to therapy- chemo and

bone marrow transplantation

cardiovascular system

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