OXYGENATION CARDIOVASCULAR AND HEMATOLOGIC SYSTEM

CARDIOVASCULAR SYSTEM

TERMINOLOGIES VENTILATION – MOVEMENT OF AIR IN & OUT OF THE LUNGS RESPIRATION – EXCHANGE OF GASES : EXTERNAL & INTERNAL EXTERNAL – BET. ALVEOLI & PULMONARY CAPILLARIES INTERNAL – BET. SYSTEMIC CAPILLARIES PERFUSION – AVAILABILITY & MOVEMENT OF CAPILLARY BLOOD FOR EXCHANGE OF GASES

VENTILATION – MOVEMENT OF AIR IN & OUT OF THE LUNGS

RESPIRATION – EXCHANGE OF GASES : EXTERNAL & INTERNAL

EXTERNAL – BET. ALVEOLI & PULMONARY CAPILLARIES

INTERNAL – BET. SYSTEMIC CAPILLARIES

PERFUSION – AVAILABILITY & MOVEMENT OF CAPILLARY BLOOD FOR EXCHANGE OF GASES

CASE STUDY You are the Emergency Room nurse A patient came in, 48 y.o., dyspneic , with the following vital signs : T= 38C, RR=50, CR=105, BP=160/110 mmHg

You are the Emergency Room nurse

A patient came in, 48 y.o., dyspneic , with the following vital signs : T= 38C, RR=50, CR=105, BP=160/110 mmHg

CASE STUDY You noted that the patient is jaundiced, with bipedal edema, and prefer to sit than lie down. What is your immediate nursing action even without the doctor’s order?

You noted that the patient is jaundiced, with bipedal edema, and prefer to sit than lie down.

What is your immediate nursing action even without the doctor’s order?

CASE STUDY What nursing history would you ask ? What other nursing assessment would you do? What is your plan for the patient?

What nursing history would you ask ?

What other nursing assessment would you do?

What is your plan for the patient?

CARDIOVASCULAR SYSTEM Review of Anatomy & Physiology Assessment : History and Physical Assessment Diagnostics Planning

Review of Anatomy & Physiology

Assessment : History and Physical Assessment

Diagnostics

Planning

REVIEW OF ANATOMY AND PHYSIOLOGY- Heart Structures Blood Supply – LCA, RCA, veins Conductive System –Sino-atrial node AV node Bundle of His Bundle branch Purkinje fibers

Structures

Blood Supply – LCA, RCA, veins

Conductive System –Sino-atrial node AV node Bundle of His Bundle branch Purkinje fibers

HEART RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION

CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE

REVIEW OF ANATOMY AND PHYSIOLOGY- Heart Nervous System Control SYMPATHETIC PARASYMPATHETIC

Nervous System Control

SYMPATHETIC

PARASYMPATHETIC

REVIEW OF ANATOMY AND PHYSIOLOGY- Heart Properties of the Heart: All or None Principle Rhythmicity Excitability Refractoriness Conductivity Automaticity Extensibility

Properties of the Heart:

All or None Principle

Rhythmicity

Excitability

Refractoriness

Conductivity

Automaticity

Extensibility

REVIEW OF ANATOMY AND PHYSIOLOGY- Heart STROKE VOLUME (SV) - amount of blood pumped out with each contraction HEART RATE (HR) CARDIAC OUTPUT (CO)– volume of blood pumped out per minute =SV x HR PRELOAD AFTERLOAD

STROKE VOLUME (SV) - amount of blood pumped out with each contraction

HEART RATE (HR)

CARDIAC OUTPUT (CO)– volume of blood pumped out per minute

=SV x HR

PRELOAD

AFTERLOAD

REVIEW OF ANATOMY AND PHYSIOLOGY – Blood Vessels Arteries Microcirculation Veins Flow Regulation Pressure gradient Flow resistance Role of Blood vessels Layers of the Blood Vessels: Intima Media Adventitia

Arteries

Microcirculation

Veins

Flow Regulation

Pressure gradient

Flow resistance

Role of Blood vessels

Layers of the Blood Vessels:

Intima

Media

Adventitia

REVIEW OF ANATOMY AND PHYSIOLOGY CIRCULATION SYSTEMIC PULMONARY PORTAL

CIRCULATION

SYSTEMIC

PULMONARY

PORTAL

PULMONARY CIRCULATION RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION

SYSTEMIC CIRCULATION RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION

HISTORY AND PHYSICAL EXAM Check for: dyspnea, jaundice, edema, hemoptysis, fatigue, syncope and fainting, cyanosis , abdominal pain and discomfort, clubbing of fingers, chest pain, palpitations

Check for:

dyspnea,

jaundice,

edema,

hemoptysis,

fatigue,

syncope and fainting,

cyanosis ,

abdominal pain and discomfort,

clubbing of fingers, chest pain,

palpitations

HISTORY AND PHYSICAL EXAM Heart –I P P A aortic area, pulmonic area, tricuspid, mitral Heart Sounds S1- AV valve closure S2 semilunar v. closure S3 vent. Gallop S4 atrial gallop Murmurs rubs

Heart –I P P A

aortic area,

pulmonic area,

tricuspid,

mitral

Heart Sounds

S1- AV valve closure

S2 semilunar v. closure

S3 vent. Gallop

S4 atrial gallop

Murmurs

rubs

HISTORY AND PHYSICAL EXAM Blood vessels Inspection color:pallor, rubor, cyanosis circulation of extremities Palpation edema, pulses Auscultation bruit

Blood vessels

Inspection

color:pallor, rubor, cyanosis

circulation of extremities

Palpation

edema, pulses

Auscultation

bruit

Diagnostic Assessment NonInvasive ECG Dynamic ECG Stress Test Treadmill Vector Cardiogram Phonocardiogram Echocardiogram Chest Xray Radionuclide Studies Venography UTZ – DOPPLER Pletysmography

NonInvasive

ECG

Dynamic ECG Stress Test

Treadmill Vector

Cardiogram

Phonocardiogram

Echocardiogram

Chest Xray

Radionuclide Studies

Venography

UTZ – DOPPLER

Pletysmography

Diagnostic Assessment Invasive Cardiac Catheterization Arteriogram Angiocardiogram Venogram Lymphogram Bone Marrow Aspiration: Sternum iliac crest tibia (infants )

Invasive

Cardiac Catheterization

Arteriogram

Angiocardiogram

Venogram

Lymphogram

Bone Marrow Aspiration:

Sternum

iliac crest

tibia (infants )

Diagnostic Assessment Blood and Urine Studies CBC Hematocrit Clotting time PT PTT APTT ESR lipid profile serum enzymes: SGOT, SGPT, LDH, CPK VMA Renin Test Schilling’s Test

Blood and Urine Studies

CBC

Hematocrit

Clotting time

PT

PTT

APTT

ESR

lipid profile

serum enzymes: SGOT, SGPT, LDH, CPK

VMA

Renin Test

Schilling’s Test

HEMODYNAMICS MONITORING CVP n= 6 -12 cm water Measures: cardiac efficiency, bld volume, peripheral resistance, right ventricular pressure 0-pt be at mid axillary line, 5 cm below the sternum dc ventilator with reading = fluid overload, = hypovolemia

CVP n= 6 -12 cm water

Measures:

cardiac efficiency,

bld volume,

peripheral resistance,

right ventricular pressure

0-pt be at mid axillary line, 5 cm below the sternum

dc ventilator with reading

= fluid overload, = hypovolemia

HEMODYNAMICS MONITORING Pulmonary Artery and Pulmonary Wedge Pressure Swan Ganz catheter : floated at the right heart, measures left side of the heart Intraarterial Blood Pressure : Radial Artery, Allen’s Test

Pulmonary Artery and Pulmonary Wedge Pressure

Swan Ganz catheter :

floated at the right heart,

measures left side of the heart

Intraarterial Blood Pressure :

Radial Artery,

Allen’s Test

Planning for Health Promotion Modification of High Risk Factors Promotion of Circulation Prevention of Infection syphillis, staph, strep, german measles Genetic counselling Role of nutrition

Modification of High Risk Factors

Promotion of Circulation

Prevention of Infection

syphillis,

staph, strep,

german measles

Genetic counselling

Role of nutrition

Modification of High Risk Factors dyslipedemia hypertension smoking sedentary lifestyle obesity stress glucose intolerance, alcohol abuse caffeine pollution

dyslipedemia

hypertension

smoking

sedentary lifestyle

obesity

stress

glucose intolerance,

alcohol abuse

caffeine

pollution

Planning for Health Maintenance & Restoration Basic Life Support Advanced Life Support Client With Cardiac Surgery: Closed Heart surgery Open Heart Surgery Heart Transpant

Basic Life Support

Advanced Life Support

Client With Cardiac Surgery:

Closed Heart surgery

Open Heart Surgery

Heart Transpant

Closed Heart surgery valvutomy mitral commisurotomy

valvutomy

mitral commisurotomy

Open Heart surgery (CABG) COMPLICATIONS : DYSRHYTHMIAS THROMBOSIS AND PULMONARY EMBOLISM CARDIOGENIC SHOCK BLEEDING WOUND INFECTION RENAL FAILURE ELECTROLYTE IMBALANCE POST-OP PSYCHOSIS

COMPLICATIONS :

DYSRHYTHMIAS

THROMBOSIS AND PULMONARY EMBOLISM

CARDIOGENIC SHOCK

BLEEDING

WOUND INFECTION

RENAL FAILURE

ELECTROLYTE IMBALANCE

POST-OP PSYCHOSIS

HEART TRANSPLANT CRITERIA 1. End Stage of Disease 2. Freedom from Chronic Disease 3. Family Support 4. Age < 50 yo 5. No psychological problem IMPORTANT 1. Immunosuppressant & Steroids – 4 hrs prior 2. Donor-Recipient Compatibility – size, crossmatching 3. Donor Heart – saline solution 4C up to 4 hrs

CRITERIA

1. End Stage of Disease

2. Freedom from Chronic Disease

3. Family Support

4. Age < 50 yo

5. No psychological problem

IMPORTANT

1. Immunosuppressant & Steroids – 4 hrs prior

2. Donor-Recipient Compatibility – size, crossmatching

3. Donor Heart – saline solution 4C up to 4 hrs

CARDIOVASCULAR DISTURBANCES CORONARY / ISCHEMIC HEART DISEASE Arteriosclerotic Heart Disease Angina Pectoris Coronary Insufficiency Myocardial Infarction CONGESTIVE HEART FAILURE HYPERTENSION PERIPHERAL VASCULAR DISEASE DISORDERS OF THE BLOOD

CORONARY / ISCHEMIC HEART DISEASE

Arteriosclerotic Heart Disease

Angina Pectoris

Coronary Insufficiency

Myocardial Infarction

CONGESTIVE HEART FAILURE

HYPERTENSION

PERIPHERAL VASCULAR DISEASE

DISORDERS OF THE BLOOD

ARTERIOSCLEROTIC HEART DISEASE Plaque formation and internal thickening (intima) Fibrosis and calcification (media) Narrowing and constriction of coronary arteries S/sx of ISCHEMIA

ARTERIOSCLEROTIC HEART DISEASE

ANGINA PECTORIS 1. STABLE 2. UNSTABLE 3. PRINZMETAL – coronary artery spasm 4. NOCTURNAL 5. DECUBITUS

1. STABLE

2. UNSTABLE

3. PRINZMETAL – coronary artery spasm

4. NOCTURNAL

5. DECUBITUS

ISCHEMIA VS INFARCTION NO STRESS/ EXERTION PRECIPITANTS PERMANENT NO PERMANENT CARDIAC TISSUE DAMAGE NOT RELIEVED RELIEVED REST NITROGLYCERINE > 5 MIN 3-5 MIN DURATION SUBSTERNAL CONSTRICTIVE (+ SX OF SHOCK) SUBSTERNAL PRESSURE/ HEAVINESS SQUEEZING PAIN INFARCTION ISCHEMIA

ANGINA PECTORIS DIAGNOSIS: Nitro Test 0.4mg NURSING GOALS: 1. O2 to myocardium 2. O2 demand 3. Prevent future episodes of angina

DIAGNOSIS:

Nitro Test 0.4mg

NURSING GOALS:

1. O2 to myocardium

2. O2 demand

3. Prevent future episodes of angina

O2 to Myocardium : Antiplatelets Calcium Blockers Beta blockers Whisky/Brandy Nitrates : RAPID-ACTING : Nitroglycerine Nitrostat AmylNitrate LONG-ACTING: ISDN,ISMN, Nitroglycerine ointment, Transdermal, IV

Antiplatelets

Calcium Blockers

Beta blockers

Whisky/Brandy

Nitrates :

RAPID-ACTING :

Nitroglycerine

Nitrostat

AmylNitrate

LONG-ACTING:

ISDN,ISMN, Nitroglycerine ointment, Transdermal,

IV

O2 Demand Limit activities – CBR Moderate Exercise Sedatives Warmth

Limit activities – CBR

Moderate Exercise

Sedatives

Warmth

Prevent Future Episodes DIET – low calorie, low saturated fat No tobacco Stress Reduction (Anger Management)

DIET – low calorie, low saturated fat

No tobacco

Stress Reduction (Anger Management)

Coronary Insufficiency IMBALANCE BETWEEN : OXYGEN SUPPLY OXYGEN DEMAND

IMBALANCE BETWEEN :

OXYGEN SUPPLY

OXYGEN DEMAND

MYOCARDIAL INFARCTION IRREVERSIBLE CARDIAC DAMAGE FROM OCCLUSION OF 1 OR MORE CORONARY ARTERY REVIEW OF ANATOMY AND PHYSIOLOGY E.C.G. Recent M.I. – ST elevation (injury) T wave inversion (ischemia) Previous M.I. – Q wave (necrosis / old infarct) BLOOD STUDIES Troponin T & I LDH CPK MB

IRREVERSIBLE CARDIAC DAMAGE FROM OCCLUSION OF 1 OR MORE CORONARY ARTERY

REVIEW OF ANATOMY AND PHYSIOLOGY

E.C.G.

Recent M.I. – ST elevation (injury)

T wave inversion (ischemia)

Previous M.I. – Q wave (necrosis / old infarct)

BLOOD STUDIES

Troponin T & I

LDH

CPK MB

P Q R S T E.C.G.

P Q R S T E.C.G. ST SEGMENT ELEVATION

P Q R S T E.C.G. INVERTED T - WAVE

P Q R S T E.C.G. Q wave

MYOCARDIAL INFARCTION NURSING CARE 1. Pain relief – Morphine ( + preload & afterload) Demerol causes vomiting 2. Oxygen 3. Inotropics 4. Beta Blockers 5. Antiarrhythmics 6. No ice or very hot drinks 7. Anticoagulants 8. ECG and CVP monitoring 9. Laxatives – Lactulose 10. PTCA 11. Thrombolytic Therapy BEFORE CELLULAR DEATH, US. 6 HRS AFTER THE ATTACK

NURSING CARE

1. Pain relief –

Morphine ( + preload & afterload)

Demerol causes vomiting

2. Oxygen

3. Inotropics

4. Beta Blockers

5. Antiarrhythmics

6. No ice or very hot drinks

7. Anticoagulants

8. ECG and CVP monitoring

9. Laxatives – Lactulose

10. PTCA

11. Thrombolytic Therapy

BEFORE CELLULAR DEATH, US. 6 HRS AFTER THE ATTACK

CARDIAC ARRHYTHMIA Review Conduction Pathway Review the Basics of Normal ECG

Review Conduction Pathway

Review the Basics of Normal ECG

CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE

P Q R S T E.C.G.

CARDIAC ARRHYTHMIA Sinus Tachycardia – P wave precede each QRS >100 bpm Sinus Bradycardia – P wave precede each QRS <60 bpm Atrial Fibrillation: P wave = f waves; QRS = normal

Sinus Tachycardia – P wave precede each QRS >100 bpm

Sinus Bradycardia – P wave precede each QRS <60 bpm

Atrial Fibrillation: P wave = f waves; QRS = normal

P Q R S T E.C.G.

CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE

CARDIAC ARRHYTHMIA Premature Ventricular Contraction: P wave normal: early QRS Ventricular Tachycardia : 3 or more PVCs Asystole – no cardiac activity

Premature Ventricular Contraction: P wave normal: early QRS

Ventricular Tachycardia : 3 or more PVCs

Asystole – no cardiac activity

P Q R S T E.C.G.

CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE

CARDIAC ARRHYTHMIA Nursing Management Oxygen Complete Bed Rest Cardioversion/ defibrillation Administer antiarrhythmics as prescribed: Atropine Beta blocker- propanolol Lidocaine Epinephrine

Nursing Management

Oxygen

Complete Bed Rest

Cardioversion/ defibrillation

Administer antiarrhythmics as prescribed:

Atropine

Beta blocker- propanolol

Lidocaine

Epinephrine

CONGESTIVE HEART FAILURE Review of Anatomy and Physiology Backward Failure Forward Failure Left-Sided Right Sided Hypermetabolic Failure Clinical Manifestations according to: Tissue Anoxia Pulmonary Hypertension Systemic congestion

Review of Anatomy and Physiology

Backward Failure

Forward Failure

Left-Sided

Right Sided

Hypermetabolic Failure

Clinical Manifestations according to:

Tissue Anoxia

Pulmonary Hypertension

Systemic congestion

C.H.F. RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION LV

CONGESTIVE HEART FAILURE Review of Anatomy and Physiology Backward Failure Forward Failure Left-Sided Right Sided Hypermetabolic Failure Clinical Manifestations according to: Tissue Anoxia Pulmonary Hypertension Systemic congestion

Review of Anatomy and Physiology

Backward Failure

Forward Failure

Left-Sided

Right Sided

Hypermetabolic Failure

Clinical Manifestations according to:

Tissue Anoxia

Pulmonary Hypertension

Systemic congestion

CONGESTIVE HEART FAILURE Diagnostics Nursing Management Goals : CARDIAC LOAD REST AND SEDATION 2. CARDIAC CONTRACTILITY CHRONOTROPICS – DIGITALIS Increase in force of contraction monitor serum K, C/I if HR </= 60 bpm, DIGITALIS TOXICITY

Diagnostics

Nursing Management

Goals :

CARDIAC LOAD

REST AND SEDATION

2. CARDIAC CONTRACTILITY

CHRONOTROPICS – DIGITALIS

Increase in force of contraction

monitor serum K,

C/I if HR </= 60 bpm,

DIGITALIS TOXICITY

CONGESTIVE HEART FAILURE SODIUM REABSORPTION AND FLUID RETENTION - DIURETICS ( Thiazide, Loop, K-sparing) -measure UO -weigh patient -watch for s/sx of electrolyte imbalance - DIET : Sodium Restricted (0.5gm/day)

SODIUM REABSORPTION AND FLUID RETENTION

- DIURETICS ( Thiazide, Loop, K-sparing)

-measure UO

-weigh patient

-watch for s/sx of electrolyte imbalance

- DIET : Sodium Restricted (0.5gm/day)

CONGESTIVE HEART FAILURE 4. PREVENTION OF COMPLICATIONS: Intractable HF Pulmonary edema Pulmonary Infarction Myocardial Infarction Digitalis Toxicity Cardiac Arrhythmia Pneumonia

4. PREVENTION OF COMPLICATIONS:

Intractable HF

Pulmonary edema

Pulmonary Infarction

Myocardial Infarction

Digitalis Toxicity

Cardiac Arrhythmia

Pneumonia

PULMONARY EDEMA Emergency! Fluid into the alveoli, bronchi & bronchioles S/SX: … of CHF Dyspnea Cough with pink frothy sputum

Emergency!

Fluid into the alveoli, bronchi & bronchioles

S/SX:

… of CHF

Dyspnea

Cough with pink frothy sputum

PULMONARY EDEMA MANAGEMENT: Oxygenation Assist in Intubation Rotating tourniquet Phlebotomy CVP monitoring

MANAGEMENT:

Oxygenation

Assist in Intubation

Rotating tourniquet

Phlebotomy

CVP monitoring

HYPERTENSION IN SYSTOLIC PRESSURE >140 IN DIASTOLIC PRESSURE > 90 CLASSIFICATION : PRIMARY BENIGN- GRADUAL MALIGNANT -ABRUPT ONSET ;SHORT COURSE SECONDARY: Renal patho, Adrenal patho, Genetics

IN SYSTOLIC PRESSURE >140

IN DIASTOLIC PRESSURE > 90

CLASSIFICATION :

PRIMARY

BENIGN- GRADUAL

MALIGNANT -ABRUPT ONSET ;SHORT COURSE

SECONDARY: Renal patho, Adrenal patho, Genetics

HYPERTENSION >=100 >=160 or HPN, Stage 2 90-99 140-159 or HPN, Stage 1 80-89 120-139 or PreHPN <180 <120 and Normal DBP mmHg SBP mmHg CATEGORY

HYPERTENSION Assess for Major CVD Risk Factors Assess for Identifiable Causes of Hypertension: Sleep apnea Drug-Induced related Chronic Kidney Disease Primary Aldosteronism Renovascular Disease Cushing’s Syndrome/steroid Therapy Pheochromocytoma Coarctation of the Aorta

Assess for Major CVD Risk Factors

Assess for Identifiable Causes of Hypertension:

Sleep apnea

Drug-Induced related

Chronic Kidney Disease

Primary Aldosteronism

Renovascular Disease

Cushing’s Syndrome/steroid Therapy

Pheochromocytoma

Coarctation of the Aorta

HYPERTENSION Diagnostics Nursing Care : Teach about: modification of Lifestyle, diet, avoidance of stimulants and coffee Administer meds as prescribed: ANTIHYPERTENSIVES AND DIURETICS Hypertensive Crisis : DIAZOXIDE (Hyperstat), NaNITROPRUSSIDE (Nipride)

Diagnostics

Nursing Care :

Teach about: modification of Lifestyle, diet, avoidance of stimulants and coffee

Administer meds as prescribed: ANTIHYPERTENSIVES AND DIURETICS

Hypertensive Crisis : DIAZOXIDE (Hyperstat), NaNITROPRUSSIDE (Nipride)

PERIPHERAL VASCULAR DISEASE ISCHEMIA OF THE PERIPHERAL VESSELS Review of Peripheral Vascular Structures Signs and Symptoms of Ischemia Coldness Pallor Rubor Cyanosis Pain ( Intermittent Claudication)

ISCHEMIA OF THE PERIPHERAL VESSELS

Review of Peripheral Vascular Structures

Signs and Symptoms of Ischemia

Coldness

Pallor

Rubor

Cyanosis

Pain ( Intermittent Claudication)

ISCHEMIA OF THE PERIPHERAL VESSELS Nursing Management Increase Arterial Blood Flow or Venous return Promote Vasodilation Prevent and Treat Vascular Occlusion

Nursing Management

Increase Arterial Blood Flow or Venous return

Promote Vasodilation

Prevent and Treat Vascular Occlusion

Increase Arterial Blood Flow or Venous return Proper positioning Exercise Short walks Buerger Allen Routine Oscillating Bed Circoelectric Bed

Proper positioning

Exercise

Short walks

Buerger Allen Routine

Oscillating Bed

Circoelectric Bed

Buerger Allen Routine 1. FEET UP , 3 MIN 2. SIT ON BED & DO FOOT EXERCISE,3 MIN 3. LIE DOWN 5 MIN

1. FEET UP , 3 MIN

2. SIT ON BED & DO FOOT EXERCISE,3 MIN

3. LIE DOWN 5 MIN

Increase Arterial Blood Flow or Venous return Patient education Decrease wieght Avoid prolonged standing Never wear constricting garments Never cross legs

Patient education

Decrease wieght

Avoid prolonged standing

Never wear constricting garments

Never cross legs

Promote Vasodilation Warmth No nicotine Vasodilators : papaverine HCl, vasodilan Moderate alcohol sympathectomy

Warmth

No nicotine

Vasodilators : papaverine HCl, vasodilan

Moderate alcohol

sympathectomy

Prevent and Treat Vascular Occlusion - avoid prolonged bedrest -increase fluids -proper positions -anticoagulant therapy & fibrinolytics Heparin - APTT- Protamine SO4 Dicumarol- PT - Vit K

- avoid prolonged bedrest

-increase fluids

-proper positions

-anticoagulant therapy & fibrinolytics

Heparin - APTT- Protamine SO4

Dicumarol- PT - Vit K

ARTERIAL DISEASE ARTERIOSCLEROSIS OBLITERANS – LATE STAGE OF ATHEROSCLEROSIS WITH PARTIAL OR COMPLETE OCCLUSION BY ATHEROMA WITH THROMBOSIS RAYNAUD’S DISEASE – PERIODIC SPASM OF THE ARTERIES ANEURYSMS – LOCALIZED OR DIFFUSED ARTERIAL DILATION EMBOLUS/THROMBUS

ARTERIOSCLEROSIS OBLITERANS – LATE STAGE OF ATHEROSCLEROSIS WITH PARTIAL OR COMPLETE OCCLUSION BY ATHEROMA WITH THROMBOSIS

RAYNAUD’S DISEASE – PERIODIC SPASM OF THE ARTERIES

ANEURYSMS – LOCALIZED OR DIFFUSED ARTERIAL DILATION

EMBOLUS/THROMBUS

VENOUS DISEASE THROMBOPHLEBITIS – INFLAMMATION OF THE VEIN WITH CLOT FORMATION HOMAN’S SIGN PHLEBOTHROMBOSIS CLOTS WITHOUT INFLAMMATION VARICOSE VEINS TRENDELENBERG’S TEST – NORMAL VEIN FILLS FROM BELOW

THROMBOPHLEBITIS –

INFLAMMATION OF THE VEIN WITH CLOT FORMATION

HOMAN’S SIGN

PHLEBOTHROMBOSIS

CLOTS WITHOUT INFLAMMATION

VARICOSE VEINS

TRENDELENBERG’S TEST – NORMAL VEIN FILLS FROM BELOW

DISEASE OF ARTERIES AND VEINS BUERGER’S DSE / Thromboangitis Obliterans RECURRING INFLAMMATION OF ARTERIES & VEINS SMOKING INTERMITTENT CLAUDICATION A-V FISTULA ABN COMMUNICATION BETWEEN A. & V. TRAUMATIC/ CONGENITAL BRUIT

BUERGER’S DSE / Thromboangitis Obliterans

RECURRING INFLAMMATION OF ARTERIES & VEINS

SMOKING

INTERMITTENT CLAUDICATION

A-V FISTULA

ABN COMMUNICATION BETWEEN A. & V.

TRAUMATIC/ CONGENITAL

BRUIT

NURSING CARE OF PATIENTS WITH AMPUTATION Control Bleeding – Bandage Prevent Edema – elevate 1 st 24 hrs Relieving Phantom Limb Pain – hypnosis, destruction Assume Body Alignment – Prone 30 min 2x a day to prevent flexion contracture ; AKA – HIP FLEXION AND ABDUCTION, EXTERNAL ROTATION BKA – KNEE FLEXION

Control Bleeding – Bandage

Prevent Edema – elevate 1 st 24 hrs

Relieving Phantom Limb Pain – hypnosis, destruction

Assume Body Alignment – Prone 30 min 2x a day to prevent flexion contracture ; AKA – HIP FLEXION AND ABDUCTION, EXTERNAL ROTATION BKA – KNEE FLEXION

NURSING CARE OF PATIENTS WITH AMPUTATION Trochanter roll against the hip along the outer side to prevent outward rotation Preparing for Locomotion Stump care : wash with soap and water only Exercise : quad setting, isometric Crutch walking : weight- palms, stairs : GOOD LEG FIRST TO HEAVEN; BAD LEG FIRST TO HELL

Trochanter roll against the hip along the outer side to prevent outward rotation

Preparing for Locomotion

Stump care : wash with soap and water only

Exercise : quad setting, isometric

Crutch walking : weight- palms, stairs : GOOD LEG FIRST TO HEAVEN; BAD LEG FIRST TO HELL

The acute nursing management of a client with CHF will include all of the following goals except: Increase in cardiac output Elevation in renal blood flow Reduction in the heart’s workload Decrease in myocardial contractility

The acute nursing management of a client with CHF will include all of the following goals except:

Increase in cardiac output

Elevation in renal blood flow

Reduction in the heart’s workload

Decrease in myocardial contractility

end of cardiovascular system

Hematologic System

REVIEW OF ANATOMY AND PHYSIOLOGY – Blood and Lymphatics Composition of the blood RBC, WBC, Platelets, Plasma RBC normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt; HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer WBC granulocytes –neutrophils, eosinophils, basophils agaranulocytes –lymphocytes (T,B), monocytes Plasma albumin, water, clotting factors, antibodies

Composition of the blood

RBC, WBC, Platelets, Plasma

RBC

normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt;

HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer

WBC

granulocytes –neutrophils, eosinophils, basophils

agaranulocytes –lymphocytes (T,B), monocytes

Plasma

albumin, water, clotting factors, antibodies

REVIEW OF ANATOMY AND PHYSIOLOGY – Blood and Lymphatics Role of the Bone Marrow Production of all blood components Major Roles of the Blood homeostasis transport of nutrients and electrolytes distribute hormones and electrolytes Major Role of Lymphatics brings back blood to the circulation immune antibody production

Role of the Bone Marrow

Production of all blood components

Major Roles of the Blood

homeostasis

transport of nutrients and electrolytes

distribute hormones and electrolytes

Major Role of Lymphatics

brings back blood to the circulation

immune antibody production

HEMATOLOGIC DISTURBANCES DISORDERS OF THE BLOOD RBC : IDA, PERNICIOUS ANEMIA, APLASTIC ANEMIA, HEMOLYTIC ANEMIA, POLYCYTHEMIA VERA WBC and Plasma Cell : LEUKEMIA, MULTIPLE MYELOMA Lymph Nodes and Spleen : LYMPHOMA, INFECTIOUS MONONUCLEOSIS, SPLENIC RUPTURE, HYPERSPLENISM Hemorrhagic Disorders : PURPURA Altered Coagulation : HEMOPHILIA, HYPOPROTHROMBINEMIA, D.I.C.

DISORDERS OF THE BLOOD

RBC : IDA, PERNICIOUS ANEMIA, APLASTIC ANEMIA, HEMOLYTIC ANEMIA, POLYCYTHEMIA VERA

WBC and Plasma Cell : LEUKEMIA, MULTIPLE MYELOMA

Lymph Nodes and Spleen : LYMPHOMA, INFECTIOUS MONONUCLEOSIS, SPLENIC RUPTURE, HYPERSPLENISM

Hemorrhagic Disorders : PURPURA

Altered Coagulation : HEMOPHILIA, HYPOPROTHROMBINEMIA, D.I.C.

HEMATOLOGIC DISTURBANCES RBC : IDA PERNICIOUS ANEMIA APLASTIC ANEMIA HEMOLYTIC ANEMIA POLYCYTHEMIA VERA

RBC :

IDA

PERNICIOUS ANEMIA

APLASTIC ANEMIA

HEMOLYTIC ANEMIA

POLYCYTHEMIA VERA

NUTRITIONAL ANEMIA IRON DEFICIENCY ANEMIA PERNICIOUS ANEMIA

IRON DEFICIENCY ANEMIA

PERNICIOUS ANEMIA

IRON DEFICIENCY ANEMIA Composition of the blood RBC, WBC, Platelets, Plasma RBC normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt; HEMOBGLOBIN : IRON ; Oxygen transport; Acid-base buffer WBC granulocytes –neutrophils, eosinophils, basophils agaranulocytes –lymphocytes (T,B), monocytes Plasma albumin, water, clotting factors, antibodies

Composition of the blood

RBC, WBC, Platelets, Plasma

RBC

normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt;

HEMOBGLOBIN : IRON ; Oxygen transport; Acid-base buffer

WBC

granulocytes –neutrophils, eosinophils, basophils

agaranulocytes –lymphocytes (T,B), monocytes

Plasma

albumin, water, clotting factors, antibodies

IRON DEFICIENCY ANEMIA HEMOGLOBIN LEVEL FALLS BELOW NORMAL CAUSES: Poor intake if iron rich foods Poor absorption & utilization of iron from foods Acute / chronic blood loss

HEMOGLOBIN LEVEL FALLS BELOW NORMAL

CAUSES:

Poor intake if iron rich foods

Poor absorption & utilization of iron from foods

Acute / chronic blood loss

Poor intake if iron rich foods increased requirement : infants after 6 mos, children & adolescents women of reproductive age pregnant & nursing women Erroneous food practices Respiratory & GI conditions Substandard living condition

increased requirement :

infants after 6 mos,

children & adolescents

women of reproductive age

pregnant & nursing women

Erroneous food practices

Respiratory & GI conditions

Substandard living condition

IRON DEFICIENCY ANEMIA CAUSES: Poor intake if iron rich foods Poor absorption & utilization of iron from foods Acute / chronic blood loss

CAUSES:

Poor intake if iron rich foods

Poor absorption & utilization of iron from foods

Acute / chronic blood loss

Poor absorption & utilization of iron from foods Form of Iron- hemosiderin: from animal food more readily absorbed than from plants (nonheme iron) Effects of other foods inhibit absorption of iron: tea, unpolished rice, veges: bulaklak ng kalabasa, sampalok, mustasa

Form of Iron-

hemosiderin: from animal food

more readily absorbed than from plants (nonheme iron)

Effects of other foods

inhibit absorption of iron:

tea, unpolished rice, veges: bulaklak ng kalabasa, sampalok, mustasa

Poor absorption & utilization of iron from foods Host factors : poor iron absorption in: severe protein-energy malnutrition & repeated diarrhea Infections Delibitating disease

Host factors :

poor iron absorption in:

severe protein-energy malnutrition & repeated diarrhea

Infections

Delibitating disease

IRON DEFICIENCY ANEMIA CAUSES: Poor intake if iron rich foods Poor absorption & utilization of iron from foods Acute / Chronic blood loss

CAUSES:

Poor intake if iron rich foods

Poor absorption & utilization of iron from foods

Acute / Chronic blood loss

Acute / Chronic blood loss Acute hemorrhage Chronic or repeated Blood loss: WHIPWORM 0.005 ML OF BLOOD PER WORM PER DAY HOOKWORM 0.2 ML OF BLOOD PER WORM PER DAY SCHISTOSOMIASIS MALARIA PEPTIC ULCER EXCESSIVE MENSTRUAL FLOW

Acute hemorrhage

Chronic or repeated Blood loss:

WHIPWORM

0.005 ML OF BLOOD PER WORM PER DAY

HOOKWORM

0.2 ML OF BLOOD PER WORM PER DAY

SCHISTOSOMIASIS

MALARIA

PEPTIC ULCER

EXCESSIVE MENSTRUAL FLOW

IRON DEFICIENCY ANEMIA CLINICAL FEATURES: Asymptomatic inability to respond to increased iron demand Normal Hgb levels but with s/sx : lack of energy, fatiguability, reduced power and concentration Severe anemia : difficulty in breathing, palpitation, headache, faintness loss of appetite

CLINICAL FEATURES:

Asymptomatic

inability to respond to increased iron demand

Normal Hgb levels but with s/sx :

lack of energy, fatiguability, reduced power and concentration

Severe anemia :

difficulty in breathing,

palpitation,

headache,

faintness

loss of appetite

IRON DEFICIENCY ANEMIA ASSESSMENT: Lab: DECREASED HEMOGLOBIN & HEMATOCRIT LEVEL MICROCYTIC, HYPOCHROMIC RBC DECREASED RETICULOCYTE COUNT Clinical Method HISTORY CLINICAL EXAMINATION - PALLOR

ASSESSMENT:

Lab:

DECREASED HEMOGLOBIN & HEMATOCRIT LEVEL

MICROCYTIC, HYPOCHROMIC RBC

DECREASED RETICULOCYTE COUNT

Clinical Method

HISTORY

CLINICAL EXAMINATION - PALLOR

IRON DEFICIENCY ANEMIA TREATMENT: IRON ADMINISTRATION: ORAL ADULT : 100-120 mg/day INFANTS AND CHILDREN : 3mg/kg/day PARENTERAL IRON DEXTRAN IM : 250 MG FOR EACH gm% LOWER THAN THE NORMAL VALUE IV: 100-300 mg in 500ml SALINE SOLUTION

TREATMENT:

IRON ADMINISTRATION:

ORAL

ADULT : 100-120 mg/day

INFANTS AND CHILDREN : 3mg/kg/day

PARENTERAL IRON DEXTRAN

IM : 250 MG FOR EACH gm% LOWER THAN THE NORMAL VALUE

IV: 100-300 mg in 500ml SALINE SOLUTION

ORAL IRON ADMINISTRATION ABSORPTION : GREATEST DURING THE FIRST MONTH OF TX, AND DECREASES WHEN IRON STORES ARE INCREASING EMPTY STOMACH: GOOD ABSORPTION, MORE G.I. S/E ADMINISTER DURING OR PC ASCORBIC ACID BETTER ABSORBED IN FERROUS THAN IN FERRIC FORM FERROUS SULFATE IS THE CHEAPEST AND READILY ABSORBABLE FORM DOSE: CALCULATE THE ELEMENTAL IRON FERROUS SULFATE HAS 36.74% ELEMENTAL IRON

ABSORPTION :

GREATEST DURING THE FIRST MONTH OF TX, AND DECREASES WHEN IRON STORES ARE INCREASING

EMPTY STOMACH: GOOD ABSORPTION, MORE G.I. S/E

ADMINISTER DURING OR PC

ASCORBIC ACID

BETTER ABSORBED IN FERROUS THAN IN FERRIC FORM

FERROUS SULFATE IS THE CHEAPEST AND READILY ABSORBABLE FORM

DOSE: CALCULATE THE ELEMENTAL IRON

FERROUS SULFATE HAS 36.74% ELEMENTAL IRON

ORAL IRON ADMINISTRATION DURATION: 2 MOS, ANEMIA IS ALREADY ALLEVIATED 5 MOS, FOR IRON STORES PREGNANT : 24 TH WK TO TERM SIDE EFFECTS: CONSTIPATION/DIARRHEA NAUSEA EPIGASTRIC PAIN / HEART BURN

DURATION:

2 MOS, ANEMIA IS ALREADY ALLEVIATED

5 MOS, FOR IRON STORES

PREGNANT : 24 TH WK TO TERM

SIDE EFFECTS:

CONSTIPATION/DIARRHEA

NAUSEA

EPIGASTRIC PAIN / HEART BURN

PARENTERAL IRON ADMINISTRATION INDICATIONS: SEVERE DEFICIENCY ORAL PREPARATIONS FAIL CONDITION DO NOT PERMIT ORAL ADMINISTRATION ABSORPTION: RAPID THERAPEUTIC RESPONSE SAME WITH ORAL

INDICATIONS:

SEVERE DEFICIENCY

ORAL PREPARATIONS FAIL

CONDITION DO NOT PERMIT ORAL ADMINISTRATION

ABSORPTION:

RAPID

THERAPEUTIC RESPONSE

SAME WITH ORAL

PARENTERAL IRON ADMINISTRATION ADVANTAGE: S/E ARE AVOIDED PROBLEMS WITH ABSORPTION IS AVOIDED DISADVANTAGE: COSTLY TOXICITY IS POSSIBLE ALLERGIC REACTION

ADVANTAGE:

S/E ARE AVOIDED

PROBLEMS WITH ABSORPTION IS AVOIDED

DISADVANTAGE:

COSTLY

TOXICITY IS POSSIBLE

ALLERGIC REACTION

PARENTERAL IRON ADMINISTRATION PRECAUTION: GIVEN UNDER CLOSE SUPERVISION BY PHYSICIAN Z-TRACK METHOD TISSUE STAINING & IRRITATION

PRECAUTION:

GIVEN UNDER CLOSE SUPERVISION BY PHYSICIAN

Z-TRACK METHOD

TISSUE STAINING & IRRITATION

IRON TOXICITY VERY RARE IN ORAL SIDEROSIS HEMOSIDERIN IN TISSUES HEMOCHROMATOSIS END POINT OF SIDEROSIS, DAMAGE TO LIVER AND PANCREAS PREVENTION: ADMIN IN DIVIDED DOSES KEEP OUT OF CHILDREN’S REACH

VERY RARE IN ORAL

SIDEROSIS

HEMOSIDERIN IN TISSUES

HEMOCHROMATOSIS

END POINT OF SIDEROSIS,

DAMAGE TO LIVER AND PANCREAS

PREVENTION:

ADMIN IN DIVIDED DOSES

KEEP OUT OF CHILDREN’S REACH

MEASURES TO MINIMIZE IRON REQUIREMENTS PARASITE CONTROL ADMINISTER MEDS FOR PARASITISM MINIMIZE RISK OF REINFESTATION: REGULAR DEWORMING – EVERY 4-6 MOS FOOTWEAR PROPER USE OF LATRINE FAMILY PLANNING DECREASE THE # OF PREGNANCIES AND DELIVERIES IUD – INCREASED MENSTRUAL LOSSES POST-DELIVERY MEASURES LATCH ON – OXYTOCIN RELEASE CUT THE CORD AFTER PULSATION STOPS

PARASITE CONTROL

ADMINISTER MEDS FOR PARASITISM

MINIMIZE RISK OF REINFESTATION:

REGULAR DEWORMING – EVERY 4-6 MOS

FOOTWEAR

PROPER USE OF LATRINE

FAMILY PLANNING

DECREASE THE # OF PREGNANCIES AND DELIVERIES

IUD – INCREASED MENSTRUAL LOSSES

POST-DELIVERY MEASURES

LATCH ON – OXYTOCIN RELEASE

CUT THE CORD AFTER PULSATION STOPS

MEASURES TO DIRECTLY AUGMENT IRON STORES SUPLEMENTATION PREGNANT 24 WKS TO TERM NURSING MOTHERS MALNOURISHED INFANTS & PRESCHOOLERS PRETERM INFANTS FORTIFICATION EDUCATION

SUPLEMENTATION

PREGNANT 24 WKS TO TERM

NURSING MOTHERS

MALNOURISHED INFANTS & PRESCHOOLERS

PRETERM INFANTS

FORTIFICATION

EDUCATION

Burger King guest

PERNICIOUS ANEMIA REVIEW OF ANATOMY & PHYSIOLOGY : STOMACH Stores and mixes food with gastric juices & mucus producing chemical & mechanical changes in the bolus of food Sphincters: cardiac and pyloric Divisions: fundus, body, antrum Secretions: Pepsinogen : by chief cells HCl: by parietal cells Intrinsic factor : by parietal cells mucoid

REVIEW OF ANATOMY & PHYSIOLOGY : STOMACH

Stores and mixes food with gastric juices & mucus producing chemical & mechanical changes in the bolus of food

Sphincters: cardiac and pyloric

Divisions: fundus, body, antrum

Secretions:

Pepsinogen : by chief cells

HCl: by parietal cells

Intrinsic factor : by parietal cells

mucoid

PERNICIOUS ANEMIA Composition of the blood RBC, WBC, Platelets, Plasma RBC normal erythropoeisis requires : pyridoxine, Vitamin B12 , folic acid, protein, copper, cobalt; HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer WBC granulocytes –neutrophils, eosinophils, basophils agaranulocytes –lymphocytes (T,B), monocytes Plasma albumin, water, clotting factors, antibodies

Composition of the blood

RBC, WBC, Platelets, Plasma

RBC

normal erythropoeisis requires : pyridoxine, Vitamin B12 , folic acid, protein, copper, cobalt;

HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer

WBC

granulocytes –neutrophils, eosinophils, basophils

agaranulocytes –lymphocytes (T,B), monocytes

Plasma

albumin, water, clotting factors, antibodies

PERNICIOUS ANEMIA No INTRINSIC FACTOR VIT B 12 cannot be absorbed Alteration in DNA synthesis needed for cell division Delayed cellular division, altered nuclear pattern MEGALOBLAST Ineffective erythropoeisis : increased serum bilirubin & urobilinogen excretion

PERNICIOUS ANEMIA OTHER TISSUES AFFECTED BY VIT B12 DEFICIENCY: MOUTH STOMACH VAGINA MYELIN SHEATH

OTHER TISSUES AFFECTED BY VIT B12 DEFICIENCY:

MOUTH

STOMACH

VAGINA

MYELIN SHEATH

PERNICIOUS ANEMIA S/SX: WEAKNESS, FATIGUE, PALLOR, JAUNDICE SORE MOUTH, SMOOTH BEEFY TONGUE ATROPHY OF THE GASTRIC MUCOSA PERIPHERAL NERVE DEGENERATION : TINGLING, NUMBNESS OF HANDS AND FEET LOSS OF COORDINATION, +ROMBERG’S

S/SX:

WEAKNESS, FATIGUE, PALLOR, JAUNDICE

SORE MOUTH, SMOOTH BEEFY TONGUE

ATROPHY OF THE GASTRIC MUCOSA

PERIPHERAL NERVE DEGENERATION : TINGLING, NUMBNESS OF HANDS AND FEET

LOSS OF COORDINATION, +ROMBERG’S

PERNICIOUS ANEMIA DIAGNOSIS: PERIPHERAL SMEAR : MACROCYTIC CELLS (+) ROMBERG’S GASTRIC ANALYSIS (diagnex blue test) – ACHLORHYDRIA from thinning of mucosa – HCl is also produced by parietal cells of the stomach SCHILLING’S TEST – B12 IN 24 HRS URINE SPEC

DIAGNOSIS:

PERIPHERAL SMEAR : MACROCYTIC CELLS

(+) ROMBERG’S

GASTRIC ANALYSIS

(diagnex blue test) – ACHLORHYDRIA from thinning of mucosa – HCl is also produced by parietal cells of the stomach

SCHILLING’S TEST – B12 IN 24 HRS URINE SPEC

SCHILLING’S TEST DEFINITIVE TEST FOR PERNICIOUS ANEMIA DETECT LACK OF INTRINSIC FACTOR MEASURES ABSORPTION OF RADIOACTIVE VIT B12 BOTH BEFORE & AFTER PARENTERAL ADMINISTRATION OF INTRINSIC FACTOR FASTING CLIENT IS GIVEN RADIOACTIVE VIT B12 BY MOUTH AND NONRADIOACTIVE VIT B12 IM

DEFINITIVE TEST FOR PERNICIOUS ANEMIA

DETECT LACK OF INTRINSIC FACTOR

MEASURES ABSORPTION OF RADIOACTIVE VIT B12 BOTH BEFORE & AFTER PARENTERAL ADMINISTRATION OF INTRINSIC FACTOR

FASTING CLIENT IS GIVEN RADIOACTIVE VIT B12 BY MOUTH AND NONRADIOACTIVE VIT B12 IM

SCHILLING’S TEST 24-48 HR URINE OBTAINED & TESTED FOR VIT B 12 AFTER 1 WK, FASTING CLIENT IS GIVEN RADIOACTIVE VIT B 12 ORALLY WITH PARENTERAL HUMAN INTRINSIC FACTOR URINE TEST IS REPEATED

24-48 HR URINE OBTAINED & TESTED FOR VIT B 12

AFTER 1 WK, FASTING CLIENT IS GIVEN RADIOACTIVE VIT B 12 ORALLY WITH PARENTERAL HUMAN INTRINSIC FACTOR

URINE TEST IS REPEATED

PERNICIOUS ANEMIA MANAGEMENT: NO CURE; VIT B12 IM FOR LIFE DIET: MEAT & DAIRY HCL : 1 ST WK; DILUTE WITH WATER; ADMINISTER WITH STRAW AVOID SEASONED FOODS

MANAGEMENT:

NO CURE; VIT B12 IM FOR LIFE

DIET: MEAT & DAIRY

HCL :

1 ST WK;

DILUTE WITH WATER;

ADMINISTER WITH STRAW

AVOID SEASONED FOODS

PERNICIOUS ANEMIA MANAGEMENT: MOUTH CARE: SOFT TOOTHBRUSH AVOID HEATING PADS – DECREASE IN SENSATION AFTER 2-3 DAYS TX, INCREASE IN RETICULOCYTE COUNT REHAB & PT FOR NEURODEFICITS

MANAGEMENT:

MOUTH CARE: SOFT TOOTHBRUSH

AVOID HEATING PADS – DECREASE IN SENSATION

AFTER 2-3 DAYS TX, INCREASE IN RETICULOCYTE COUNT

REHAB & PT FOR NEURODEFICITS

APLASTIC ANEMIA DEPRESSION OF ALL BLOOD FORMING ELEMENTS FROM BONE MARROW DESTRUCTION IDIOPATHIC SECONDARY

DEPRESSION OF ALL BLOOD FORMING ELEMENTS FROM BONE MARROW DESTRUCTION

IDIOPATHIC

SECONDARY

APLASTIC ANEMIA CAUSE: ANTINEOPLASTIC DRUGS & RADIATION IMMUNOSUPPRESIVE DRUGS CHLORAMPHENICOL SULFONAMIDES TOXIC SUBSTANCES: BENZENE ,DDT, THIAZIDE, DIURETICS GOLD

CAUSE:

ANTINEOPLASTIC DRUGS & RADIATION

IMMUNOSUPPRESIVE DRUGS

CHLORAMPHENICOL

SULFONAMIDES

TOXIC SUBSTANCES: BENZENE ,DDT, THIAZIDE, DIURETICS GOLD

APLASTIC ANEMIA ASSESSMENT : S/SX OF ANEMIA INCREASED SUSCEPTIBILITY TO INFECTION BLEEDING TENDENCIES & HEMORRHAGE

ASSESSMENT :

S/SX OF ANEMIA

INCREASED SUSCEPTIBILITY TO INFECTION

BLEEDING TENDENCIES & HEMORRHAGE

APLASTIC ANEMIA LAB: NORMOCYTIC ANEMIA GRANULOCYTOPENIA THROMBOCYTOPENIA BONE MARROW BIOPSY: FATTY VERY FEW DEVELOPING CELLS

LAB:

NORMOCYTIC ANEMIA

GRANULOCYTOPENIA

THROMBOCYTOPENIA

BONE MARROW BIOPSY:

FATTY

VERY FEW DEVELOPING CELLS

HEMOLYTIC ANEMIA EXCESSIVE RBC DESTRUCTION CAUSES: ACQUIRED SNAKE VENOM BURNS BT INCOMPATIBILITY MALARIA TOXOPLASMOSIS CONGENITAL HEREDITARY SPHEROCYTOSIS G6PD DEFICIENCY THALASSEMIA SICKLE CELL

CAUSES:

ACQUIRED

SNAKE VENOM

BURNS

BT INCOMPATIBILITY

MALARIA

TOXOPLASMOSIS

CONGENITAL

HEREDITARY SPHEROCYTOSIS

G6PD DEFICIENCY

THALASSEMIA

SICKLE CELL

POLYCYTHEMIA INCREASE IN CIRCULATING BLOOD CELLS IN THE BLOOD DUE TO BONE MARROW OVERGROWTH FORMS: POLYCYTHEMIA VERA SECONDARY POLYCYTHEMIA RELATIVE POLYCYTHEMIA

INCREASE IN CIRCULATING BLOOD CELLS IN THE BLOOD DUE TO BONE MARROW OVERGROWTH

FORMS:

POLYCYTHEMIA VERA

SECONDARY POLYCYTHEMIA

RELATIVE POLYCYTHEMIA

POLYCYTHEMIA ASSESSMENT : RUDDY COMPLEXION HYPERTENSION SYMPTOMS OF CHF THROMBUS FORMATION BLEEDING HEPATOSPLENOMEGALY GOUT PHLEBOTOMY

ASSESSMENT :

RUDDY COMPLEXION

HYPERTENSION

SYMPTOMS OF CHF

THROMBUS FORMATION

BLEEDING

HEPATOSPLENOMEGALY

GOUT

PHLEBOTOMY

CLINICAL CARE OF PATIENTS WITH ANEMIA REST SKIN CARE DECUBITUS ULCER FROM CELL HYPOXIA DIET 6 SMALL EASILY DIGESTIBLE MEALS NO HOT & SPICY FOODS MOUTH CARE TRANSFUSION NOT A ROUTINE OXYGEN

REST

SKIN CARE

DECUBITUS ULCER FROM CELL HYPOXIA

DIET

6 SMALL EASILY DIGESTIBLE MEALS

NO HOT & SPICY FOODS

MOUTH CARE

TRANSFUSION NOT A ROUTINE

OXYGEN

CLINICAL CARE OF PATIENTS WITH ANEMIA PROTECTION FROM INJURY BURNS and CHILLING ISLOLATION BY: REVERSE ISOLATION LIFE ISLAND- BED ENCLOSED IN PLASTIC CANOPY LAMIANR AIRFLOW LIMIT – UNIT WITH MICROFILTER

PROTECTION FROM INJURY

BURNS and CHILLING

ISLOLATION BY:

REVERSE ISOLATION

LIFE ISLAND- BED ENCLOSED IN PLASTIC CANOPY

LAMIANR AIRFLOW LIMIT – UNIT WITH MICROFILTER

Don’t look at me…

HEMATOLOGIC DISTURBANCES WBC and Plasma Cell : LEUKEMIA MULTIPLE MYELOMA

WBC and Plasma Cell :

LEUKEMIA

MULTIPLE MYELOMA

LEUKEMIA FATAL NEOPLASTIC DISEASE THAT INVOLVES THE BLOOD FORMING TISSUES OF THE: BONE MARROW SPLEEN LYMPH NODES UNCONTROLLED & DESTRUCTIVE PROLIFERATION OF ONE TYPE OF WBC & ITS PRECURSORS

FATAL NEOPLASTIC DISEASE THAT INVOLVES THE BLOOD FORMING TISSUES OF THE:

BONE MARROW

SPLEEN

LYMPH NODES

UNCONTROLLED & DESTRUCTIVE PROLIFERATION OF ONE TYPE OF WBC & ITS PRECURSORS

LEUKEMIA INFILTRATE: LIVER SKIN KIDNEYS LYMPH TISSUES TYPES: MYELOGENOUS LYMPHOCYTIC

INFILTRATE:

LIVER

SKIN

KIDNEYS

LYMPH TISSUES

TYPES:

MYELOGENOUS

LYMPHOCYTIC

LEUKEMIA S/SX: ANEMIA THROMBOCYTOPENIA INFECTION PETECHIAE HEPATOSPLENOMEGALY & LYMPH NODE ENLARGEMENT ARTHRALGIA & BONE PAIN FROM EXPANSION OF BM

S/SX:

ANEMIA

THROMBOCYTOPENIA

INFECTION

PETECHIAE

HEPATOSPLENOMEGALY & LYMPH NODE ENLARGEMENT

ARTHRALGIA & BONE PAIN FROM EXPANSION OF BM

LEUKEMIA LAB: INCREASED WBC ANEMIA THROMBOCYTOPENIA INCREASE ALKALINE PHOSPHATASE OSTEOBLASTIC ACTIVITY BONE MARROW BIOPSY

LAB:

INCREASED WBC

ANEMIA

THROMBOCYTOPENIA

INCREASE ALKALINE PHOSPHATASE

OSTEOBLASTIC ACTIVITY

BONE MARROW BIOPSY

LEUKEMIA – NURSING CARE PROVIDE ADEQUATE REST INCREASED METABOLIC RATE FROM OVERPRODUCTION OF LEUKOCYTES PAIN CONTROL ASA, CODEINE, DEMEROL ADEQUATE FOOD & FLUID INTAKE HIGH CALORIE DIET VITAMIN SUPPLEMENTS 3-4 L OF FLUID PER DAY

PROVIDE ADEQUATE REST INCREASED METABOLIC RATE FROM OVERPRODUCTION OF LEUKOCYTES

PAIN CONTROL ASA, CODEINE, DEMEROL

ADEQUATE FOOD & FLUID INTAKE HIGH CALORIE DIET VITAMIN SUPPLEMENTS 3-4 L OF FLUID PER DAY

LEUKEMIA – NURSING CARE MOUTH CARE H2O2 LEMON & GLYCERINE PREVENT INFECTION PROTECT PATIENT FROM HIS OWN FLORA – NEOMYCIN CHEMOTHERAPY GOAL- INDUCTION OF COMPLETE REMISSION TOLERABLE LEVEL OF TOXICITY – CRITERION FOR LIMITATION OF INDUCTION PHASE

MOUTH CARE H2O2 LEMON & GLYCERINE

PREVENT INFECTION PROTECT PATIENT FROM HIS OWN FLORA – NEOMYCIN

CHEMOTHERAPY

GOAL- INDUCTION OF COMPLETE REMISSION

TOLERABLE LEVEL OF TOXICITY – CRITERION FOR LIMITATION OF INDUCTION PHASE

MULTIPLE MYELOMA MOST COMMON NEOPLASTIC DISORDER OF THE PLASMA CELL BONE MARROW MALIGNANCY REVIEW OF PLASMA CELL AND ITS PRODUCTS S/SX: BACK PAIN, FATIGUE, WEIGHT LOSS, OSTEOPOROSIS HYPERCALCEMIA

MOST COMMON NEOPLASTIC DISORDER OF THE PLASMA CELL

BONE MARROW MALIGNANCY

REVIEW OF PLASMA CELL AND ITS PRODUCTS

S/SX:

BACK PAIN,

FATIGUE, WEIGHT LOSS,

OSTEOPOROSIS

HYPERCALCEMIA

MULTIPLE MYELOMA LABS: BLOOD: DECREASED WBC, HGB & PLATELET; INCREASED SERUM INMMUNEGLOBULINS RADIOLOGY DIFFUSE BONE LESIONS DIAGNOSIS: BENCE-JONES PROTEIN GLOBULIN IN THE URINE

LABS:

BLOOD: DECREASED WBC, HGB & PLATELET; INCREASED SERUM INMMUNEGLOBULINS

RADIOLOGY

DIFFUSE BONE LESIONS

DIAGNOSIS: BENCE-JONES PROTEIN GLOBULIN IN THE URINE

HEMATOLOGIC DISTURBANCES Lymph Nodes and Spleen : LYMPHOMA INFECTIOUS MONONUCLEOSIS SPLENIC RUPTURE HYPERSPLENISM

Lymph Nodes and Spleen :

LYMPHOMA

INFECTIOUS MONONUCLEOSIS

SPLENIC RUPTURE

HYPERSPLENISM

LYMPHOMA HODGKIN’S & NON HODGKIN’S DISEASE LYMPHOSARCOMA BURKITT’S LYMPHOMA

HODGKIN’S & NON HODGKIN’S DISEASE

LYMPHOSARCOMA

BURKITT’S LYMPHOMA

HODGKIN’S DISEASE MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE ENLARGEMENT OF THE LYMPH NODES NIGHT SWEATS BODY MALAISE WEIGHT LOSS REED-STERNBERG CELLS IN LYMPHNODE BIOPSY

HODGKIN’S DISEASE

MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE

ENLARGEMENT OF THE LYMPH NODES

NIGHT SWEATS

BODY MALAISE

WEIGHT LOSS

REED-STERNBERG CELLS IN LYMPHNODE BIOPSY

NONHODGKIN’S DISEASE MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE ENLARGEMENT OF THE LYMPH NODES MORE FATAL & DIFFICULT TO CONTROL UNDIFFERENTIATED CELLS IN LYMPH NODE BIOPSY

MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE

ENLARGEMENT OF THE LYMPH NODES

MORE FATAL & DIFFICULT TO CONTROL

UNDIFFERENTIATED CELLS IN LYMPH NODE BIOPSY

INFECTIOUS MONONUCLEOSIS AKA : GLANDULAR / KISSING DSE S/SX: PAINFUL ENLARGEMENT - LYMPHNODES LYMPHOCYTOSIS FEVER

AKA : GLANDULAR / KISSING DSE

S/SX:

PAINFUL ENLARGEMENT - LYMPHNODES

LYMPHOCYTOSIS

FEVER

INFECTIOUS MONONUCLEOSIS CAUSE: EPSTEIN-BARR VIRUS CONTACT: KISSING DIAGNOSIS : PAUL-BUNNEL HETEROPHIL TEST COMPLICATION : SPLENIC RUPTURE

CAUSE: EPSTEIN-BARR VIRUS

CONTACT: KISSING

DIAGNOSIS : PAUL-BUNNEL HETEROPHIL TEST

COMPLICATION : SPLENIC RUPTURE

SPLENECTOMY INDICATIONS: RUPTURE OF THE SPLEEN FROM TRAUMA, INFECTIOUS MONONUCLEOSIS HYPERSPLENISM – EXCESSIVE SPLENIC DAMAGE OF CELLULAR BLOOD COMPONENTS

INDICATIONS:

RUPTURE OF THE SPLEEN FROM TRAUMA, INFECTIOUS MONONUCLEOSIS

HYPERSPLENISM – EXCESSIVE SPLENIC DAMAGE OF CELLULAR BLOOD COMPONENTS

SPLENECTOMY NURSING CARE: PREOP PNEUMOCOCCAL VACCINE POSTOP MONITOR FOR BLEEDING & SHOCK FEVER WITHOUT INFECTION IS COMMON PROPHYLACTIC ANTIBIOTIC

NURSING CARE:

PREOP

PNEUMOCOCCAL VACCINE

POSTOP

MONITOR FOR BLEEDING & SHOCK

FEVER WITHOUT INFECTION IS COMMON

PROPHYLACTIC ANTIBIOTIC

Hemorrhagic Disorders : PURPURA EXTRAVASATION OF SMALL AMTS OF BLOOD INTO THE TISSUES AND MUCUS MEMBRANE VASCULAR PURPURA CAUSES : HEREDITY ALLERGY (HENOCH-SCHONLEIN) DRUGS (TOXIC PURPURA) POOR NUTRITION INFECTION HPN THROMBOCYTOPENIC PURPURA

EXTRAVASATION OF SMALL AMTS OF BLOOD INTO THE TISSUES AND MUCUS MEMBRANE

VASCULAR PURPURA

CAUSES :

HEREDITY

ALLERGY (HENOCH-SCHONLEIN)

DRUGS (TOXIC PURPURA)

POOR NUTRITION

INFECTION

HPN

THROMBOCYTOPENIC PURPURA

Disorders of Altered Coagulation HEMOPHILIA HYPOPROTHROMBINEMIA D.I.C.

HEMOPHILIA

HYPOPROTHROMBINEMIA

D.I.C.

HEMOPHILIA Deficit in one of the clotting factors A – Factor VIII B - Factor IX C- Factor XI

Deficit in one of the clotting factors

A – Factor VIII

B - Factor IX

C- Factor XI

HEMOPHILIA S/SX: PROLONGED BLEEDING AFTER MINOR INJURY: CUTTING OF CORD CIRCUMCISION IMMUNIZATION HEMARTHROSIS PERIPHERAL NEUROPATHY – BLEEDING NEAR PERIPHERAL NERVES LAB: PROLONGED PTT NORMAL PLT CT ANEMIA

S/SX:

PROLONGED BLEEDING AFTER MINOR INJURY:

CUTTING OF CORD

CIRCUMCISION

IMMUNIZATION

HEMARTHROSIS

PERIPHERAL NEUROPATHY – BLEEDING NEAR PERIPHERAL NERVES

LAB:

PROLONGED PTT

NORMAL PLT CT

ANEMIA

HYPOPROTHROMBINEMIA LIVER FAILURE BLEEDING EPISODES VITAMIN K

LIVER FAILURE

BLEEDING EPISODES

VITAMIN K

D.I.C. 2 CONFLICTING SETS OF MANIFESTATIONS: DIFFUSE FIBRIN DEPOSITION WITHIN ARTERIOLES AND CAPILLARIES THROUGHOUT THE BODY BLEEDING INTO THE KIDNEYS, BRAIN, ADRENAL, HEART AND OTHER ORGANS

2 CONFLICTING SETS OF MANIFESTATIONS:

DIFFUSE FIBRIN DEPOSITION WITHIN ARTERIOLES AND CAPILLARIES THROUGHOUT THE BODY

BLEEDING INTO THE KIDNEYS, BRAIN, ADRENAL, HEART AND OTHER ORGANS

D.I.C. DIFFUSE FIBRIN DEPOSITION WIHIN ARTERIOLES AND CAPILLARIES WIDESPREAD CLOTTING DEPLETION OF CLOTTING FACTORS

D.I.C. CAUSE: UNKNOWN CRITICAL ILLNESS: TOXEMIA OF PREGNANCY CANCER SURGICAL PROBLEMS HEMOLYTIC DSE ASSESMENT: PETECHIAE, ECCHYMOSIS PROLONGED BLEEDING ARF CONVULSIONS COMA LAB: FIBRIN SPLIT PRODUCTS

CAUSE:

UNKNOWN

CRITICAL ILLNESS:

TOXEMIA OF PREGNANCY

CANCER

SURGICAL PROBLEMS

HEMOLYTIC DSE

ASSESMENT:

PETECHIAE, ECCHYMOSIS

PROLONGED BLEEDING

ARF

CONVULSIONS

COMA

LAB:

FIBRIN SPLIT PRODUCTS

A.I.D.S. Severe deficit in cellular immune functions HIV virus- infects T helper cells Transmission Antiretroviral drugs Assessment: Flulike s/sx Hypoxemia from pulm infection Progressive weight loss Temp elevations; night sweats Neurologic dyfxn Opportunistic infections Laboratory : ELISA Western Blot Anemia Leukopenia thrombocytopenia

Severe deficit in cellular immune functions

HIV virus- infects T helper cells

Transmission

Antiretroviral drugs

Assessment:

Flulike s/sx

Hypoxemia from pulm infection

Progressive weight loss

Temp elevations; night sweats

Neurologic dyfxn

Opportunistic infections

Laboratory :

ELISA

Western Blot

Anemia

Leukopenia

thrombocytopenia

A.I.D.S. NURSING INTERVENTION: Administer meds Monitor resp, neurologic, F & E balance Monitor nutritional intake Inspect oral cavity for ulcerations Observe s/sx of infection Severe leukopenia – neutropenic precaution Blood & body fluid precaution Emotional support

NURSING INTERVENTION:

Administer meds

Monitor resp, neurologic, F & E balance

Monitor nutritional intake

Inspect oral cavity for ulcerations

Observe s/sx of infection

Severe leukopenia – neutropenic precaution

Blood & body fluid precaution

Emotional support

The nurse should understand that a heparin order for a client with DIC is given to: Prevent clot formation Increase blood flow to target organs Increase clot formation Decrease blood flow to target organs

The nurse should understand that a heparin order for a client with DIC is given to:

Prevent clot formation

Increase blood flow to target organs

Increase clot formation

Decrease blood flow to target organs

GOD BLESS