Cardio and Hemato PPT

7/30/2019 Cardio and Hemato PPT

1/66

Cardiologic&

HematologicConditions


2/66

Cardiologic Disorders


3/66

Coronary Atherosclerosis

an abnormal accumulation of lipid, orfatty, substances and fibrous tissue in thevessel wall.


4/66

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


5/66

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


6/66


7/66

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.


8/66



9/66


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.


10/66

Structural, Infectious and

Inflammatory Cardiac Disorders


11/66

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


12/66

Mitral Regurgitation

regurgitation involvesblood flowing backfrom the left ventricle

into the left atriumduring systole. Often,the margins of the

mitral valve cannotclose during systole.


13/66

Mitral Regurgitation


Dyspnea,

fatigue,

weakness

Palpitations

shortness of breath on exertion

cough from pulmonary congestion alsooccur


14/66

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


15/66

Mitral Stenosis

ClinicalManifestations:

dyspnea

fatigue experience

repeated

respiratoryinfections


16/66

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.


17/66

Aortic Regurgitation


breathing difficulties

exertional dyspnea fatigue


18/66

Aortic Stenosis

is narrowing of the orifice between the leftventricle and the aorta

Clinical Manifestations: exertional dyspnea

dizziness

syncope

Angina Pectoris


19/66

Cardiomyopathies


20/66

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


21/66

Types of Cardiomyopathy

Dilated

Hypertrophic

Restrictive Arrhythmogenic

Right Ventricular

Unclassified


22/66



23/66



24/66

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


25/66

Congestive Heart Failure


26/66

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


27/66

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.


28/66

Left-sided heart failure


Dyspnea

Orthopnea Paroxysmal nocturnal dyspnea


29/66

Pathophysiology for Left sided CHF
http://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docx


30/66

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).


31/66

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


32/66

Pathophysiology for Right-sided

CHF
http://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docxhttp://localhost/var/www/apps/conversion/tmp/scratch_5/PATHOPHYSIOLOGY%20OF%20CHF.docx


33/66

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.


34/66

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


35/66

Management for CHF


36/66

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


37/66

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


38/66

MEDICATION/PHARMACOLOGIC TREATMENT

Diuretics (water pills) mainstay oftherapy and helps reduce fluidaccumulation.

Administer Oxygen


39/66

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


40/66

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


41/66

Hematologic Disorders


42/66


43/66

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


44/66

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


45/66

Management for Anemia


46/66

Medical Management

Medications and treatments that correct thecommon underlying causes of anemiainclude the following:

Iron supplements

Vitamin supplements may replace folateand vitamin B12


47/66

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.


48/66

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)


49/66

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


50/66

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).


51/66

The leukemias are commonly classifiedaccording to the stem cell line involved,

either lymphoid or myeloid:1. Acute Myeloid Leukemia

2.Acute Lymphocytic Leukemia


52/66

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


53/66


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


54/66

Acute Lymphocytic Leukemia

results from an uncontrolled proliferationof immature cells (lymphoblasts) derivedfrom the lymphoid stem cell


Pain from an enlarged liver or spleen

Bone pain

Headache and vomiting (because ofmeningeal involvement).


55/66


56/66

Leukemia

Lab assessment

Decreased H&H

Decreased platelets

Altered WBC (low, normal, elevated: usually20,000 to 100,000

Bone marrow aspiration/biopsy identifies

types


57/66

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)


58/66

Management for Leukemia


59/66

Medical Management

People with leukemia have manytreatment options. The options arewatchful waiting, chemotherapy, targeted

therapy, biological therapy, radiationtherapy, and stem cell transplant.


60/66

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


61/66

Nursing Management

dietary

provide low-microbial diet

encourage adequate hydration


62/66

Nursing Management

Patient

avoid suppositories, enemas, rectaltemperatures

practice deep breathing while awake

ambulate: use mask

prevent dry skin with the use of lubricants


63/66

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


64/66

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.


65/66

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


66/66

Cardio and Hemato PPT

Documents

Transcript of Cardio and Hemato PPT