Unit 7 Cardiovascular, Hematologic and Oncology Disorders Chapters 25, 26, 29.
-
Upload
shonda-cathleen-mcbride -
Category
Documents
-
view
218 -
download
0
Transcript of Unit 7 Cardiovascular, Hematologic and Oncology Disorders Chapters 25, 26, 29.
Anatomy and Physiology
• Normal cardiac anatomy
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-2
Congenital Heart Defects: Atrial Septal Defects
• Abnormal connection between the right and left atria
• Pathophysiology• Clinical manifestations• Diagnosis• Treatment
– Diuretics for congestive heart failure– Surgical repair
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-3
Atrial Septal Defects
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-4
Congenital Heart Defect: Ventricular Septal Defect
• Pathophysiology– Blood flows left to right– Heart enlargement– Pulmonary vessel congestion
• Clinical manifestations– Asymptomatic– Congestive heart failure
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-5
(continues)
Congenital Heart Defect: Ventricular Septal Defect
• Diagnosis: loud holosystolic murmur• Treatment
– May close by 2 years of age– Surgical repair
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-6
Ventricular Septal Defect
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-7
Congenital Heart Defect: Patent Ductus Arteriosus
• Incidence and etiology• Pathophysiology: left to right shunt• Clinical manifestations
– Asymptomatic– Congestive heart failure
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-8
(continues)
Congenital Heart Defect: Patent Ductus Arteriosus
• Diagnosis– Continuous murmur below left clavicle– X ray
• Treatment– Indomethacin for preterm only– Surgery– Nonsurgical closure
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-9
Patent Ductus Arteriosus
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-10
Defects with Decreased Pulmonary Blood Flow: Pulmonary Stenosis
• Pathophysiology– Obstruction of blood flow from RV to pulmonary
artery– Increased RV pressure
• Clinical manifestations– Mild to moderate in newborns; can be
asymptomatic in infants– Severe pulmonary stenosis: dyspnea with exertion
and fatigue
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-11
(continues)
Defects with Decreased Pulmonary Blood Flow: Pulmonary Stenosis
• Diagnosis• Treatment
– Surgical– Balloon valvuloplasty– Surgical valvuloplasty
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-12
Defect with Decreased Pulmonary Blood Flow: Tetralogy of Fallot
• Ventricular septal defect • Pulmonary stenosis• Right ventricular hypertrophy• Overriding aorta• Incidence and etiology• Pathophysiology
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-13
(continues)
Defect with Decreased Pulmonary Blood Flow: Tetralogy of Fallot
• Clinical manifestations– Varies with degree of pulmonary stenosis– Cyanotic or without cyanosis
• Diagnosis• Treatment
– Surgical correction– Preoperative management– Palliative: modified Blalock-Taussig shunt
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-14
Defects that Obstruct Left Ventricular Outflow: Hypoplastic Left Heart Syndrome
• Diagnosis• Treatment
– Cardiac transplantation– Palliative surgery
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-15
Acquired Heart Disease: Acute Rheumatic Fever
• Incidence and etiology– Strep pharyngitis– Group A streptococci
• Pathophysiology• Clinical manifestations• Diagnosis• Treatment• Nursing management and family teaching
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-16
(continues)
Acquired Heart Disease: Kawasaki Disease
• Incidence and etiology• Pathophysiology• Clinical manifestations• Diagnosis• Treatment• Nursing management and family teaching
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-17
(continues)
Acquired Heart Disease: Hypertension
• Incidence and etiology• Clinical manifestations• Diagnosis
Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson
Learning Inc. All rights reserved.25-18
(continues)
Iron-Deficiency Anemia
• Incidence and etiology • Pathophysiology
– Lack of dietary iron – Chronic intestinal blood loss
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-19
(continues)
Iron-Deficiency Anemia
• Clinical manifestations– Mild
• Asymptomatic
– Moderate • General irritability • Weakness• Lack of interest in play
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-20
(continues)
Iron-Deficiency Anemia
• Severe – Cardiac murmurs – Congestive heart failure – Pallor – Impaired healing – Thinning hair – Abdominal pain, anorexia – Low-grade fever
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-21
(continues)
Iron-Deficiency Anemia
• Diagnosis • Treatment
– Infants– School-age children– Pregnant adolescents
• Nursing management
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-22
Sickle Cell Anemia
• Incidence and etiology • Pathophysiology • Clinical manifestations
– Signs and symptoms • Similar to other anemias • Delayed growth • Delayed onset of puberty
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-23
(continues)
Sickle Cell Anemia
– Vaso-occlusive crisis – Hand-foot syndrome – Sequestration crisis – Aplastic crisis
• Diagnosis• Treatment
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-24
(continues)
Aplastic Anemia
• Clinical manifestations– Bruising – Vulnerable to infection – Signs and symptoms of anemia – Impaired growth and development – 5% to 10% develop acute myelogenous leukemia
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-25
(continues)
Aplastic Anemia
• Diagnosis • Treatment
– Platelet transfusion – Packed red blood cells – Antibiotics if fever is present– Bone marrow transplant – Immunosuppressive therapy
• Nursing management Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-26
Disorders of Coagulation: Hemophilia
• Incidence and etiology – Hemophilia A– Hemophilia B – Hemophilia C
• Pathophysiology
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-27
(continues)
Disorders of Coagulation: Hemophilia
• Clinical manifestations – Bleeding episodes – Hematomas – Hemarthrosis– Hematuria – Epistaxis
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-28
(continues)
Disorders of Coagulation: Hemophilia
• Diagnosis • Treatment
– Infusions – Replacing missing coagulation factors – Desmopressin
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-29
Immune Thrombocytopenic Purpura (ITP)
• Incidence and etiology – Thrombocytopenia– Purpura
• Pathophysiology
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-30
(continues)
Immune Thrombocytopenic Purpura (ITP)
• Clinical manifestations – Acute onset – Ecchymoses – Petechial rash – 1 to 4 weeks after viral infection – Spontaneous bleeding – Hemorrhagic blisters
• Diagnosis • Treatment • Nursing management
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
26-31
Cancer Treatment Modalities
• Goals: to rid the body of all malignant cells, thereby curing the cancer
• Surgery• Chemotherapy• Radiation therapy• Bone marrow transplantation• Biologic response modifiers
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
29-32
Leukemia
• Clinical manifestations – Fever – Bone pain– Pallor– Bruising
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
29-33
Acute Lymphocytic Leukemia
• Diagnosis:– Bone marrow aspiration (more than 25%
abnormal lymphoblasts) – Lumbar puncture– Chest X ray
• Treatment
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
29-34
Lymphomas
• Malignancies that arise from the lymphoid system
• Hodgkin’s disease• Non-Hodgkin’s lymphoma
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
29-35
Neuroblastoma
• A tumor originating from neural crest cells, which are embryologic precursors of the adrenal medulla and sympathetic nervous system
• Clinical manifestations• Diagnosis• Treatments• Nursing management
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
29-36
Wilms’ Tumor
• Incidence and etiology• Pathophysiology• Clinical manifestations• Diagnosis• Treatment• Nursing management
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
29-37
Croup
• Croupy or “barking” cough• Inspiratory stridor• Some degree of respiratory distress
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-39
Treatment of Croup
• Nebulized racemic epinephrine• Systemic or nebulized corticosteroids• Fluids, rest, comfort
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-40
Acute Epiglottitis
• Life-threatening bacterial infection• Respiratory distress, fever, sore throat,
dysphagia, drooling, agitation, and lethargy
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-41
Asthma
• Characterized by chronic inflammation, bronchoconstriction, and bronchial hyper-responsiveness
• Wheezing, coughing, and dyspnea• Airways are damaged over time• Classified by severity of symptoms
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-42
Pharmacologic Treatments
• Short-acting inhaled beta-2 agonists• Long-acting inhaled beta-2 agonists• Leukotriene modifiers• Oral antiasthmatics• Methylxanthines• Systemic corticosteroids
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-43
Nursing Management/Nursing Diagnoses
• Risk for suffocation related to airway obstruction
• Ineffective airway clearance related to allergic and inflammatory processes
• Interrupted family processes related to child with chronic illness
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-44
Cystic Fibrosis
• Inherited disorder affecting the exocrine glands
• Alterations in sweat electrolytes and mucus production lead to multisystem damage
• Chronic infection and airway obstruction lead to bronchiectasis, pneumothorax, and cor pulmonale
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-45
Treatments and Nursing Management
• Maximizing lung functioning – Promote the removal of secretions from the
lungs.– Prevent and treat lung infections.– Manage pulmonary complications.
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-46
(continues)
Treatments and Nursing Management
• Medications – Inhaled recombinant human deoxyribo-nuclease
(DNase)– Antibiotics– Pancreatic enzymes and vitamins A, D, E, K
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
24-47
(continues)