Transcript Chpt 42 PPT

Chapter 42
CARDIOVASCULAR, RESPIRATORY,
AND LYMPHATIC DISORDERS
1
Normal Blood Flow Through
the Heart
https://youtu.be/l7ejcLxKW8c
Slide 2
Cardiovascular Disorders
The circulatory (cardiovascular) system delivers blood to the body’s
cells. Problems that occur in the heart or blood vessels include:
◦
◦
◦
◦
◦
◦
Hypertension
Coronary artery disease (CAD)
Angina
Myocardial infarction
Heart failure
Dysrhythmias
Slide 3
Cardiovascular Disorders
(cont’d)
◦ With hypertension, the resting blood pressure is too high.
◦ Systolic pressure = 140 mm Hg or higher; or
◦ Diastolic pressure = 90 mm Hg or higher
◦ Pre-hypertension will likely develop into hypertension in the future.
◦ Systolic pressure = 120 – 139 mm Hg; or
◦ Diastolic pressure = 80 – 89 mm Hg
◦ Causes include:
◦ Narrowed blood vessels, kidney disorders, head injuries, some pregnancy problems, and adrenal
gland tumors.
Slide 4
Hypertension Video
https://youtu.be/diG519dFVNs
Slide 5
Cardiovascular Disorders
(cont’d)
◦ Hypertension can lead to:
◦ Stroke
◦ Hardening of the arteries
◦ Heart attack
◦ Heart failure
◦ Kidney failure
◦ Blindness
◦ Life-style changes can lower blood pressure.
◦ A diet low in fat and salt
◦ A healthy weight
◦ Regular exercise
◦ Not smoking
◦ Limiting alcohol and caffeine
◦ Managing stress and sleeping well
◦ Certain drugs can lower blood pressure.
Slide 6
Cardiovascular Disorders
(cont’d)
◦ In coronary artery disease (CAD; coronary
heart disease; heart disease), the coronary
arteries become hardened and narrow.
◦ One or all of the arteries are affected.
◦ The heart muscle gets less blood and oxygen
◦ The most common cause is
atherosclerosis.
◦ The major complications of CAD are:
◦ Angina
◦ Myocardial infarction (heart attack)
◦ Irregular heartbeats
◦ Sudden death
◦ The more risk factors, the greater the
chance of CAD and its complications.
Slide 7
Cardiovascular Disorders
(cont’d)
◦ CAD can be treated. Treatment goals are to:
◦ Relieve symptoms.
◦ Slow or stop atherosclerosis.
◦ Lower the risk of blood clots.
◦ Widen or bypass clogged arteries.
◦ Reduce cardiac events.
◦ CAD requires life-style changes. The person must:
◦ Quit smoking.
◦ Exercise.
◦ Reduce stress.
◦ Eat a healthy diet.
◦ If over-weight, lose weight.
Slide 8
Cardiovascular Disorders
(cont’d)
◦ Some persons need drugs to:
◦ Decrease the heart’s workload and relieve symptoms.
◦ Prevent a heart attack or sudden death.
◦ Delay the need for medical and surgical procedures that open or bypass diseased arteries.
◦ CAD complications may require cardiac rehabilitation.
◦ The cardiac rehab team includes:
◦ Doctors (the person’s doctor, heart specialist, heart surgeon)
◦ Nurses
◦ Exercise specialists, physical and occupational therapists, dietitians, and mental health
professionals
◦ Cardiac rehab has two parts.
◦ Exercise training
◦ Education, counseling, and training
Slide 9
Cardiovascular Disorders
(cont’d)
◦ Angina (pain) is chest pain from
reduced blood flow to part of the heart
muscle (myocardium).
◦ It occurs when the heart needs more oxygen.
◦ It is described as tightness, pressure, squeezing,
or burning in the chest.
◦ Symptoms can be relieved.
◦ Rest often relieves symptoms in 3 to 15
minutes.
◦ A nitroglycerin tablet is taken when angina
occurs.
◦ Some persons have nitroglycerin patches.
◦ Things that cause angina are avoided.
◦ Chest pain lasting longer than a few
minutes and not relieved by rest and
nitroglycerin may signal a heart attack.
The person needs emergency care.
Slide 10
Types of Angina
Slide 11
Cardiovascular Disorders
(cont’d)
◦ With myocardial infarction (MI), part of
the heart muscle dies.
◦ Sudden cardiac death (cardiac arrest) can occur.
◦ MI also is called:
◦ Heart attack
◦ Acute myocardial infarction (AMI)
◦ Acute coronary syndrome (ACS)
◦ Coronary
◦ Coronary thrombosis
◦ Coronary occlusion
◦ In MI, blood flow to the heart muscle is
suddenly blocked.
Slide 12
Cardiovascular Disorders
(cont’d)
◦ CAD, angina, and previous MI are risk factors.
◦ MI is an emergency.
◦ Efforts are made to:
◦ Relieve pain (MONA)
◦ Restore blood flow to the heart (PCI)
◦ Stabilize vital signs (Add Defib pads)
◦ Give oxygen
◦ Calm the person
◦ Prevent death and life-threatening problems
◦ The person may need:
◦ Medical or surgical procedures to open or bypass the
diseased artery
◦ Cardiac rehabilitation
Slide 13
Percutaneous Coronary
Intervention (PCI)
https://youtu.be/I45kJJoCa6s
Slide 14
Cardiovascular Disorders
(cont’d)
◦ Heart failure or congestive heart failure (CHF) occurs when the weakened
heart cannot pump normally.
◦ When the left side of the heart cannot pump blood normally, blood backs up into the lungs.
◦ Respiratory congestion occurs.
◦ The person has dyspnea, increased sputum, cough, and gurgling sounds in the lungs.
◦ When the right side of the heart cannot pump blood normally, blood backs up into the venous
system.
◦ Feet and ankles swell.
◦ Neck veins bulge.
◦ Liver congestion affects liver function.
◦ The abdomen is congested with fluid.
◦ A very severe form of heart failure is pulmonary edema (fluid in the lungs).
Slide 15
Heart Failure
LEFT SIDED HEART FAILURE
RIGHT SIDED HEART FAILURE
Slide 16
Cardiovascular Disorders
(cont’d)
◦ Common causes of heart failure are:
◦ CAD
◦ MI
◦ Hypertension
◦ Diabetes
◦ Age
◦ Irregular heart rhythms
◦ Damaged heart valves
◦ Kidney disease
Slide 17
Cardiovascular Disorders
(cont’d)
◦ Treatment involves:
◦ Drugs are ordered to strengthen the heart.
◦ Drugs are ordered to reduce the amount of fluid in the body.
◦ A sodium-controlled diet is ordered.
◦ Oxygen is given.
◦ Semi-Fowler’s position is preferred for breathing.
◦ The person must reduce CAD risk factors.
◦ If acutely ill, the person needs hospital care.
Slide 18
Cardiovascular Disorders
(cont’d)
◦ Dysrhythmia is an abnormal heart rhythm. The rhythm may be:
Energy
Drinks
◦ Too fast, too slow, or irregular
◦ Dysrhythmias are caused by:
◦ Changes in the heart’s electrical system
◦ CAD, MI, or heart failure
◦ Weakening and changes in the heart muscle
◦ Drug and alcohol abuse
◦ Excess caffeine intake
Illicit
Drugs
◦ Thyroid problems
◦ Some drugs
◦ Some dysrhythmias are minor. Others are life-threatening.
Slide 19
Cardiovascular Disorders
(cont’d)
◦ Treatment depends on the type of
dysrhythmia.
◦ Drugs may be given.
◦ A procedure may be needed.
◦ Defibrillation or cardioversion—an electrical
shock is given to stop an abnormal rhythm
◦ Ablation—areas of tissue in the heart sending
abnormal electrical signals are destroyed
◦ Internal devices may be placed.
◦ Pacemaker—device that is inserted under the
skin near the heart; it monitors and regulates
the heart’s rhythm.
◦ Implantable cardioverter defibrillator (ICD)—
used for life-threatening dysrhythmias; it
delivers a shock when the heart is in a lifethreatening rhythm; some devices are both a
pacemaker and an ICD.
Slide 20
Normal Respiratory Function
https://youtu.be/hc1YtXc_84A
Slide 21
Respiratory Disorders
The respiratory system brings oxygen (O2) into the lungs and removes
carbon dioxide (CO2) from the body.
Respiratory disorders that interfere with this function and threaten life
include:
◦
◦
◦
◦
◦
◦
◦
Chronic obstructive pulmonary disease (COPD)
Chronic bronchitis
Asthma
Sleep apnea
Influenza
Pneumonia
Tuberculosis
Slide 22
Respiratory Disorders (cont’d)
◦ Chronic obstructive pulmonary disease (COPD) involves two disorders that
interfere with the exchange of oxygen and carbon dioxide in the lungs.
◦ Chronic bronchitis and emphysema
◦ Risk factors for COPD include:
◦ Cigarette smoking; pipe, cigar, and other tobaccos
◦ Exposure to second-hand smoke
◦ Not smoking is the best way to prevent COPD.
◦ COPD has no cure.
◦ COPD affects the airways and alveoli.
◦ Airways and alveoli become less elastic.
◦ The walls between many alveoli are destroyed.
◦ Airway walls become thick, inflamed, and swollen.
◦ Airways are clogged by excess mucus secretion.
Slide 23
Respiratory Disorders (cont’d)
◦ Chronic bronchitis occurs after repeated episodes of bronchitis.
◦ Bronchitis means inflammation of the bronchi.
◦ Smoking is the major cause.
◦ Infection, air pollution, and industrial dusts are risk factors.
◦ Smoker’s cough in the morning is often the first symptom.
◦ Treatment involves:
◦ The person must stop smoking.
◦ Oxygen therapy and breathing exercises are often ordered.
◦ Respiratory tract infections are prevented.
◦ If one occurs, the person needs prompt treatment.
Slide 24
Respiratory Disorders (cont’d)
◦ In emphysema, the alveoli enlarge
and become less elastic.
◦ As a result, some air is trapped in the alveoli
when exhaling.
◦ Over time, more alveoli are involved; O2 and
CO2 exchange cannot occur in affected
alveoli, trapping more air in the lungs.
◦ Smoking is the most common cause.
◦ Air pollution and industrial dusts are risk
factors.
◦ The person has shortness of breath
and a cough.
◦ Breathing is easier when the person sits
upright and slightly forward.
◦ Treatments
◦ The person must stop smoking.
◦ Respiratory therapy, breathing exercises,
oxygen, and drug therapy are ordered.
Slide 25
Respiratory Disorders (cont’d)
◦ With asthma, the airway becomes inflamed and narrow. Extra mucus is
produced.
◦ Signs and symptoms include:
◦ Dyspnea
◦ Wheezing and coughing
◦ Pain and tightness in the chest
◦ Asthma usually is triggered by allergies.
◦ Other triggers include air pollutants, smoking, second-hand smoke, respiratory infections,
exertion, cold air.
◦ Sudden attacks (asthma attacks) can occur.
◦ Asthma is treated with drugs.
◦ Severe attacks may require emergency care.
◦ Repeated attacks can damage the respiratory system.
Slide 26
Respiratory Disorders (cont’d)
◦ In sleep apnea, pauses in breathing occur during sleep.
◦ Pauses last from a few seconds to over a minute.
◦ They can occur many times during sleep.
◦ The most common cause is blockage of the airway.
◦ Obstructive sleep apnea—during sleep, muscles in the throat relax and soft tissues collapse,
closing the airway.
◦ Central sleep apnea (less common)—occurs when the brain does not send signals to the muscles
to breathe.
Slide 27
Respiratory Disorders (cont’d)
◦ Signs and symptoms of sleep apnea include:
◦ Pauses in breathing during sleep
◦ Loud snoring
◦ Waking during sleep with a gasp or shortness of breath
◦ Difficulty staying asleep
◦ Daytime sleepiness
◦ Headache in the morning
◦ Dry mouth or sore throat after sleeping
◦ Treatment includes:
◦ Mild sleep apnea
◦ Life-style changes, weight loss, quitting smoking, and avoiding alcohol and sedatives before
sleep
◦ More severe sleep apnea
◦ Surgery
◦ Positive airway pressure device: CPAP or BiPAP
Slide 28
Respiratory Disorders (cont’d)
◦ Influenza is a respiratory infection caused by viruses.
◦ Older persons are at great risk.
◦ Pneumonia is a common complication.
◦ Treatment involves:
◦ Fluids and rest
◦ Drugs ordered by the doctor for symptom relief and to shorten the flu episode.
◦ Coughing and sneezing spread flu viruses.
◦ Follow Standard Precautions.
◦ The flu vaccine is the best prevention.
Slide 29
Respiratory Disorders (cont’d)
◦ The Centers for Disease Control and Prevention (CDC) recommends the flu
vaccine for persons who:
◦ Are 6 months to 4 years of age
◦ Are 50 years of age and older
◦ Have chronic heart, lung, liver, or kidney diseases
◦ Have diabetes
◦ Have immune system, nervous system, or blood disorders
◦ Are pregnant or will be pregnant during the flue season
◦ Are 6 months–18 years old and receiving long-term aspirin therapy
◦ Are nursing center or other long-term care residents
◦ Are American Indians or Alaska Natives
◦ Are very obese
◦ Are in close contact with children under 5 years of age (especially those in contact with children
under 6 months)
◦ Are in close contact with adults 50 years of age and older
◦ Are health care workers
◦ Have contact with persons at high risk for flu-related complications
Slide 30
Respiratory Disorders (cont’d)
◦ Pneumonia is an inflammation and infection
of lung tissue.
◦ Affected tissues fill with fluid.
◦ O2 and CO2 exchange is affected.
◦ Bacteria, viruses, and other microbes are causes.
◦ Microbes reach the lungs by being:
◦ Inhaled
◦ Aspirated
◦ Carried in the blood to the lungs from an infection in the body
◦ Children under 2 years of age and adults over 65 years of age are at risk.
Slide 31
Respiratory Disorders (cont’d)
◦ Factors that increase the risk of pneumonia include:
◦ Smoking
◦ Aging
◦ Stroke
◦ Bedrest
◦ Immobility
◦ Chronic diseases
◦ Tube feedings
◦ Treatment may include:
◦ Drugs for infection and pain
◦ Increased fluid intake to treat fever and to thin secretions
◦ Intravenous therapy and oxygen
◦ Semi-Fowler’s position to ease breathing
Slide 32
Adventitious LS: Pneumonia
https://youtu.be/5JA6D1Mguh0
Slide 33
Respiratory Disorders (cont’d)
◦ Tuberculosis (TB) is a bacterial infection in the lungs.
◦ It also can occur in other parts of the body.
◦ If TB is not treated, the person can die.
◦ TB is spread by airborne droplets with coughing, sneezing, speaking, singing,
or laughing.
◦ Those who have close, frequent contact with an infected person are at risk.
◦ Risk factors include:
◦ Living in close, crowded areas
◦ Age
◦ Poor nutrition
◦ HIV (human immunodeficiency virus)
Slide 34
Respiratory Disorders (cont’d)
◦ TB can be present in the body but not cause signs and symptoms.
◦ Only persons with an active infection can spread the disease to others.
◦ Chest x-rays and TB testing can detect the disease.
◦ Signs and symptoms include:
◦ Tiredness, loss of appetite, weight loss, fever, and night sweats.
◦ Treatment involves:
◦ Drugs for TB
◦ Standard Precautions and Isolation Precautions
◦ The person covering his or her mouth and nose with tissues when sneezing, coughing, or
producing sputum
◦ Flushing tissues down the toilet, placing them in a biohazard bag, or in a paper bag to be burned
◦ Hand washing after contact with sputum is essential.
Slide 35
Precautions for Respiratory
Disorders
http://lippincottsolutions.com/landing/ebolavirus-infection-procedures-contactprecautions
Slide 36
Lymphatic Disorders
The lymphatic system drains extra
fluid from the tissues, helps fight
infection, and absorbs and
transports fats.
Lymphatic disorders that affect
these functions include:
◦ Lymphedema
◦ Lymphoma
Slide 37
Lymphatic Disorders (cont’d)
◦ Lymphedema is a build-up of lymph in the tissues causing edema (swelling).
It occurs when there is a blockage or damage to the lymph system.
◦ Causes include:
◦ Cancer
◦ Infection
◦ Surgical removal of lymph nodes
◦ Scar tissue from radiation therapy or surgery
◦ Absent or abnormal lymph nodes present at birth
◦ Lymphedema usually affects an arm or leg.
◦ Daily activities are often affected.
◦ Damage to the lymph system cannot be reversed.
Slide 38
Lymphatic Disorders (cont’d)
◦ Treatment for lymphedema includes:
◦ Elastic garments or bandages
◦ Exercise
◦ Good skin care
◦ Massage therapy
◦ The goals are to:
◦ Control swelling.
◦ Decrease pain.
◦ Improve movement and use of the body part.
◦ Allow daily activities.
Slide 39
Lymphatic Disorders (cont’d)
◦ Lymphoma is cancer involving cells in the immune system (lymphocytes).
◦ Lymphocytes are a type of WBC that protect the body from infection.
◦ They are found in lymph nodes and other lymph tissues.
◦ In lymphoma, these cells do not function normally.
◦ There are two main types of lymphoma:
◦ Hodgkin lymphoma
◦ Non-Hodgkin lymphoma
◦ Lymphoma begins with an abnormal lymphocyte.
◦ The abnormal cell divides and makes more abnormal cells.
◦ A mass of abnormal cells develops into a tumor.
Slide 40