Coronary Artery Disease

1. Coronary Artery Disease Ischemic heart disease

2. Angina Pectoris • Development of plaques • Vessels narrow or become obstructed • Ischemia • Prolonged deficiency of oxygenated blood

3. Angina “pain in chest”

4. Signs and Symptoms • Distribution of pain • Sensation of tightening • Faint • Dyspneic • Pale

5. Diagnostic Test • ECG (ekg) • Cardiac enzymes • Xray • Medical history

6. Medical and Surgical treatment • Medications • Diet and exercise • Reduction of risk factors • Invasive and intervention procedures

7. Nursing considerations • Teaching • Lifestyle changes • Medications • Compliance

8. Myocardial Infarction • Blockage of coronary arteries • Damage to the myocardium and conduction system • Diminished blood flow • Life threatening dysrhythmias • Ineffective pump

9. Pain Panic Restlessness Confusion Ashen Cold Clammy Dyspnea Cyanosis Rapid thready pulse Irregular pulse Drop in BP Drop in body temp Sense of impending doom Signs and Symptoms

10. Diagnostic test • ECG • Cardiac enzymes • Xray • BMP • Coagulation studies

11. Medical treatment • Pain relief • Medications • Oxygen • Rest

12. Nursing Considerationsacute phase • Assessment • Vital signs • Cardiac monitoring • I/O, daily weight • Lab and xray • Medications

13. Nursing Considerationsrecovery phase • Bowel movement • Cardiac rehab-exercise • Rest • Diet • Treatment and medications • Risk factors • Compliance

14. Blood Vessel Disorders Inflammatory disorders and Complications

15. Thrombophlebitis • Inflammation • Blood clot formation • Deep vein thrombosis • Phlebitis • Coagulability

16. Thrombophlebitis • Predisposing factors • Pressure • Prolonged inactivity • Prolonged immobilization • Venous stasis • Decrease venous return

17. Signs and Symptoms • Pain • Redness • Swelling • Fever • Fatigue • Positive Homans’ sign

18. Medical treatment • Imaging studies • Medications • Lab tests • rest

19. Nursing Considerations • Exercise plan • Bed rest • Antiembolism stockings • Medications

20. Embolism • Pulmonary embolism • Coronary embolism • Cerebral embolism • Peripheral embolism

21. Surgical treatment • Ligation (tied off) • Filter placed

22. Peripheral Vascular Disorders • Intermittent claudication • Tingling and numbness • Coldness and difference in size • Lack of new tissue growth

23. Buerger’s disease • Thromoangiitis obliterans • Inflammation causes obstruction of blood vessels • Cramps in calf muscle-exercise • Tingling, burning and numbness • Edema-pitting or brawny • Mottled purple red hue- dependent • Pale when elevated • Ulcers-infection-gangrene • Amputation

24. Medical and surgical treatment • Mild exercise- buerger-allen exercises • Medications • Clothing • Diet and fluid intake

25. Raynaud’s Phenomenon • Spasmodic constriction of arteries • Blanched cold extremities • Numb-prickly- perspire-blue • Progresses-cyanosis-ulcers • Skin shiny and tight • Avoid cold • Medications to relieve spasms

26. Varicose Veins • Weakening valves of the veins • Blood pools • Predisposing factors • Heredity • Weakening vein walls • Poor posture • Prolonged standing • Tumors • Hypertension • obesity

27. Signs and symptoms • Dark, tortuous superficial veins • Dark protrusions when standing • Pain • Fatigue • Feeling of heaviness • Muscle cramps

28. Medical and Surgical treatment • Elevating legs • Avoiding constriction, standing long periods and restrictive clothing • Measures aimed at promoting venous return • Surgical ligation and stripping of varicose veins • Sclerosing-injection

29. Nursing considerations • Teaching • Measures to promote venous return • Antiembolism stockings • Elevate legs • Ambulation

30. Telangiectasia (spider veins) • Small dilated blood vessels • Treated by scleropathy

31. Aneurysms • Outpouching of a blood vessel • Congenital • Trauma • Increased pressure of arteriolosclerosis • Vessel may hemorrhage or rupture • Surgical intervention if in an operable site • Surgical repair-clamping, removal or synthetic graft

32. Cerebrovasular Accident Stroke Brain attack

33. Causes of cerebrovascular accident • Contributing factors • Causes of CVA • Cerebral thrombosis • Cerebral hemorrhage or aneurysm • Cerebral embolism

34. Stages of CVA • Transient ischemic attack • Reversible ischemic neurological deficit • Stroke in evolution • Completed stroke

35. Dizzy spells Memory loss Ringing in the ears (tinnitus) Headache-nausea and vomiting Loss of consciousness Face red Breathing noisy and strained BP elevated Pulse slow but full and bounding Inconsistent behavior Easily fatigued Loss of bowel and bladder control Poor balance Deep coma Signs and Symptoms

36. Results of CVA • Hemiplegia • Paralysis of one side of body • Flaccid stage • Numbness and weakness • Spastic stage • Muscles contracted, tense and movement difficult • Recovery stage • Therapy and rehabilitation

37. Aphasia and Dysphasia • Aphasia • Damage to the brain’s speech center • Unable to speak • Dysphasia • Inability to say what one wishes to say • Dysphagia • Swallowing difficulty

38. Brain Damage Chances of recovery Deficits

39. Hemianopsia • Blindness in half of the visual field of one or both eyes • Approach from the unaffected side • Teach client to scan to see things

40. Pain • Very little pain associated with CVA • Secondary health issues • Infection • Kidney • Bladder • Fecal impaction

41. Autonomic Disturbances • Perspiration or “goose flesh” above paralysis • Dilated pupils • High or low blood pressure • headache

42. Personality changes • Functional • Frustration unable to walk or talk • Useless or helpless • Organic changes • Blockage of blood supply to part of brain

43. Nursing Considerations • Changes in LOC • Documentation • Positioning on unaffected side • Maintain patent airway • Limb support • Monitor vital signs • Communications • Ortho bowel program • Medication and therapy