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Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
Cardiology and Hematology Ppt
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Cardiology and Hematology Ppt

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Cardiology and Hematology Ppt

Cardiology and Hematology Ppt

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  • 1. OXYGENATION CARDIOVASCULAR AND HEMATOLOGIC SYSTEM
  • 2. CARDIOVASCULAR SYSTEM
  • 3.  
  • 4. TERMINOLOGIES <ul><li>VENTILATION – MOVEMENT OF AIR IN & OUT OF THE LUNGS </li></ul><ul><li>RESPIRATION – EXCHANGE OF GASES : EXTERNAL & INTERNAL </li></ul><ul><li>EXTERNAL – BET. ALVEOLI & PULMONARY CAPILLARIES </li></ul><ul><li>INTERNAL – BET. SYSTEMIC CAPILLARIES </li></ul><ul><li>PERFUSION – AVAILABILITY & MOVEMENT OF CAPILLARY BLOOD FOR EXCHANGE OF GASES </li></ul>
  • 5. CASE STUDY <ul><li>You are the Emergency Room nurse </li></ul><ul><li>A patient came in, 48 y.o., dyspneic , with the following vital signs : T= 38C, RR=50, CR=105, BP=160/110 mmHg </li></ul>
  • 6. CASE STUDY <ul><li>You noted that the patient is jaundiced, with bipedal edema, and prefer to sit than lie down. </li></ul><ul><li>What is your immediate nursing action even without the doctor’s order? </li></ul>
  • 7. CASE STUDY <ul><li>What nursing history would you ask ? </li></ul><ul><li>What other nursing assessment would you do? </li></ul><ul><li>What is your plan for the patient? </li></ul>
  • 8. CARDIOVASCULAR SYSTEM <ul><li>Review of Anatomy & Physiology </li></ul><ul><li>Assessment : History and Physical Assessment </li></ul><ul><ul><ul><li>Diagnostics </li></ul></ul></ul><ul><ul><ul><li>Planning </li></ul></ul></ul>
  • 9. REVIEW OF ANATOMY AND PHYSIOLOGY- Heart <ul><li>Structures </li></ul><ul><li>Blood Supply – LCA, RCA, veins </li></ul><ul><li>Conductive System –Sino-atrial node AV node Bundle of His Bundle branch Purkinje fibers </li></ul>
  • 10. HEART RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION
  • 11. CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE
  • 12. REVIEW OF ANATOMY AND PHYSIOLOGY- Heart <ul><li>Nervous System Control </li></ul><ul><ul><li>SYMPATHETIC </li></ul></ul><ul><ul><li>PARASYMPATHETIC </li></ul></ul>
  • 13. REVIEW OF ANATOMY AND PHYSIOLOGY- Heart <ul><li>Properties of the Heart: </li></ul><ul><ul><li>All or None Principle </li></ul></ul><ul><ul><li>Rhythmicity </li></ul></ul><ul><ul><li>Excitability </li></ul></ul><ul><ul><li>Refractoriness </li></ul></ul><ul><ul><li>Conductivity </li></ul></ul><ul><ul><li>Automaticity </li></ul></ul><ul><ul><li>Extensibility </li></ul></ul>
  • 14. REVIEW OF ANATOMY AND PHYSIOLOGY- Heart <ul><li>STROKE VOLUME (SV) - amount of blood pumped out with each contraction </li></ul><ul><li>HEART RATE (HR) </li></ul><ul><li>CARDIAC OUTPUT (CO)– volume of blood pumped out per minute </li></ul><ul><li>=SV x HR </li></ul><ul><li>PRELOAD </li></ul><ul><li>AFTERLOAD </li></ul>
  • 15.  
  • 16. REVIEW OF ANATOMY AND PHYSIOLOGY – Blood Vessels <ul><li>Arteries </li></ul><ul><li>Microcirculation </li></ul><ul><li>Veins </li></ul><ul><li>Flow Regulation </li></ul><ul><ul><li>Pressure gradient </li></ul></ul><ul><ul><li>Flow resistance </li></ul></ul><ul><li>Role of Blood vessels </li></ul><ul><li>Layers of the Blood Vessels: </li></ul><ul><li>Intima </li></ul><ul><li>Media </li></ul><ul><li>Adventitia </li></ul>
  • 17. REVIEW OF ANATOMY AND PHYSIOLOGY <ul><li>CIRCULATION </li></ul><ul><li>SYSTEMIC </li></ul><ul><li>PULMONARY </li></ul><ul><li>PORTAL </li></ul>
  • 18. PULMONARY CIRCULATION RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION
  • 19. SYSTEMIC CIRCULATION RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION
  • 20.  
  • 21. HISTORY AND PHYSICAL EXAM <ul><li>Check for: </li></ul><ul><ul><li>dyspnea, </li></ul></ul><ul><ul><li>jaundice, </li></ul></ul><ul><ul><li>edema, </li></ul></ul><ul><ul><li>hemoptysis, </li></ul></ul><ul><ul><li>fatigue, </li></ul></ul><ul><ul><li>syncope and fainting, </li></ul></ul><ul><ul><li>cyanosis , </li></ul></ul><ul><ul><li>abdominal pain and discomfort, </li></ul></ul><ul><ul><li>clubbing of fingers, chest pain, </li></ul></ul><ul><ul><li>palpitations </li></ul></ul>
  • 22. HISTORY AND PHYSICAL EXAM <ul><li>Heart –I P P A </li></ul><ul><ul><li>aortic area, </li></ul></ul><ul><ul><li>pulmonic area, </li></ul></ul><ul><ul><li>tricuspid, </li></ul></ul><ul><ul><li>mitral </li></ul></ul><ul><li>Heart Sounds </li></ul><ul><ul><ul><li>S1- AV valve closure </li></ul></ul></ul><ul><ul><ul><li>S2 semilunar v. closure </li></ul></ul></ul><ul><ul><ul><li>S3 vent. Gallop </li></ul></ul></ul><ul><ul><ul><li>S4 atrial gallop </li></ul></ul></ul><ul><ul><ul><li>Murmurs </li></ul></ul></ul><ul><ul><ul><li>rubs </li></ul></ul></ul>
  • 23. HISTORY AND PHYSICAL EXAM <ul><li>Blood vessels </li></ul><ul><ul><li>Inspection </li></ul></ul><ul><ul><ul><li>color:pallor, rubor, cyanosis </li></ul></ul></ul><ul><ul><ul><li>circulation of extremities </li></ul></ul></ul><ul><ul><li>Palpation </li></ul></ul><ul><ul><ul><li>edema, pulses </li></ul></ul></ul><ul><ul><li>Auscultation </li></ul></ul><ul><ul><ul><li>bruit </li></ul></ul></ul>
  • 24. Diagnostic Assessment <ul><li>NonInvasive </li></ul><ul><ul><ul><li>ECG </li></ul></ul></ul><ul><ul><ul><li>Dynamic ECG Stress Test </li></ul></ul></ul><ul><ul><ul><li>Treadmill Vector </li></ul></ul></ul><ul><ul><ul><li>Cardiogram </li></ul></ul></ul><ul><ul><ul><li>Phonocardiogram </li></ul></ul></ul><ul><ul><ul><li>Echocardiogram </li></ul></ul></ul><ul><ul><ul><li>Chest Xray </li></ul></ul></ul><ul><ul><ul><li>Radionuclide Studies </li></ul></ul></ul><ul><ul><ul><li>Venography </li></ul></ul></ul><ul><ul><ul><li>UTZ – DOPPLER </li></ul></ul></ul><ul><ul><ul><li>Pletysmography </li></ul></ul></ul>
  • 25. Diagnostic Assessment <ul><ul><ul><li>Invasive </li></ul></ul></ul><ul><ul><ul><li>Cardiac Catheterization </li></ul></ul></ul><ul><ul><ul><li>Arteriogram </li></ul></ul></ul><ul><ul><ul><li>Angiocardiogram </li></ul></ul></ul><ul><ul><ul><li>Venogram </li></ul></ul></ul><ul><ul><ul><li>Lymphogram </li></ul></ul></ul><ul><ul><ul><li>Bone Marrow Aspiration: </li></ul></ul></ul><ul><ul><ul><ul><li>Sternum </li></ul></ul></ul></ul><ul><ul><ul><ul><li>iliac crest </li></ul></ul></ul></ul><ul><ul><ul><ul><li>tibia (infants ) </li></ul></ul></ul></ul>
  • 26. Diagnostic Assessment <ul><li>Blood and Urine Studies </li></ul><ul><ul><li>CBC </li></ul></ul><ul><ul><li>Hematocrit </li></ul></ul><ul><ul><li>Clotting time </li></ul></ul><ul><ul><li>PT </li></ul></ul><ul><ul><li>PTT </li></ul></ul><ul><ul><li>APTT </li></ul></ul><ul><ul><li>ESR </li></ul></ul><ul><ul><li>lipid profile </li></ul></ul><ul><ul><li>serum enzymes: SGOT, SGPT, LDH, CPK </li></ul></ul><ul><ul><li>VMA </li></ul></ul><ul><ul><li>Renin Test </li></ul></ul><ul><ul><li>Schilling’s Test </li></ul></ul>
  • 27. HEMODYNAMICS MONITORING <ul><li>CVP n= 6 -12 cm water </li></ul><ul><ul><li>Measures: </li></ul></ul><ul><ul><ul><li>cardiac efficiency, </li></ul></ul></ul><ul><ul><ul><li>bld volume, </li></ul></ul></ul><ul><ul><ul><li>peripheral resistance, </li></ul></ul></ul><ul><ul><ul><li>right ventricular pressure </li></ul></ul></ul><ul><ul><li>0-pt be at mid axillary line, 5 cm below the sternum </li></ul></ul><ul><ul><li>dc ventilator with reading </li></ul></ul><ul><ul><li>= fluid overload, = hypovolemia </li></ul></ul>
  • 28. HEMODYNAMICS MONITORING <ul><li>Pulmonary Artery and Pulmonary Wedge Pressure </li></ul><ul><ul><li>Swan Ganz catheter : </li></ul></ul><ul><ul><li>floated at the right heart, </li></ul></ul><ul><ul><li>measures left side of the heart </li></ul></ul><ul><li>Intraarterial Blood Pressure : </li></ul><ul><ul><li>Radial Artery, </li></ul></ul><ul><ul><li>Allen’s Test </li></ul></ul>
  • 29. Planning for Health Promotion <ul><ul><li>Modification of High Risk Factors </li></ul></ul><ul><ul><li>Promotion of Circulation </li></ul></ul><ul><ul><li>Prevention of Infection </li></ul></ul><ul><ul><ul><li>syphillis, </li></ul></ul></ul><ul><ul><ul><li>staph, strep, </li></ul></ul></ul><ul><ul><ul><li>german measles </li></ul></ul></ul><ul><ul><li>Genetic counselling </li></ul></ul><ul><ul><li>Role of nutrition </li></ul></ul>
  • 30. Modification of High Risk Factors <ul><ul><li>dyslipedemia </li></ul></ul><ul><ul><li>hypertension </li></ul></ul><ul><ul><li>smoking </li></ul></ul><ul><ul><li>sedentary lifestyle </li></ul></ul><ul><ul><li>obesity </li></ul></ul><ul><ul><li>stress </li></ul></ul><ul><ul><li>glucose intolerance, </li></ul></ul><ul><ul><li>alcohol abuse </li></ul></ul><ul><ul><li>caffeine </li></ul></ul><ul><ul><li>pollution </li></ul></ul>
  • 31. Planning for Health Maintenance & Restoration <ul><ul><li>Basic Life Support </li></ul></ul><ul><ul><li>Advanced Life Support </li></ul></ul><ul><ul><li>Client With Cardiac Surgery: </li></ul></ul><ul><ul><ul><li>Closed Heart surgery </li></ul></ul></ul><ul><ul><ul><li>Open Heart Surgery </li></ul></ul></ul><ul><ul><ul><li>Heart Transpant </li></ul></ul></ul>
  • 32. Closed Heart surgery <ul><ul><ul><ul><li>valvutomy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>mitral commisurotomy </li></ul></ul></ul></ul>
  • 33. Open Heart surgery (CABG) <ul><ul><ul><li>COMPLICATIONS : </li></ul></ul></ul><ul><ul><ul><ul><ul><li>DYSRHYTHMIAS </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>THROMBOSIS AND PULMONARY EMBOLISM </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>CARDIOGENIC SHOCK </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>BLEEDING </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>WOUND INFECTION </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>RENAL FAILURE </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ELECTROLYTE IMBALANCE </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>POST-OP PSYCHOSIS </li></ul></ul></ul></ul></ul>
  • 34. HEART TRANSPLANT <ul><li>CRITERIA </li></ul><ul><li>1. End Stage of Disease </li></ul><ul><li>2. Freedom from Chronic Disease </li></ul><ul><li>3. Family Support </li></ul><ul><li>4. Age < 50 yo </li></ul><ul><li>5. No psychological problem </li></ul><ul><li>IMPORTANT </li></ul><ul><li>1. Immunosuppressant & Steroids – 4 hrs prior </li></ul><ul><li>2. Donor-Recipient Compatibility – size, crossmatching </li></ul><ul><li>3. Donor Heart – saline solution 4C up to 4 hrs </li></ul>
  • 35. CARDIOVASCULAR DISTURBANCES <ul><li>CORONARY / ISCHEMIC HEART DISEASE </li></ul><ul><ul><li>Arteriosclerotic Heart Disease </li></ul></ul><ul><ul><li>Angina Pectoris </li></ul></ul><ul><ul><li>Coronary Insufficiency </li></ul></ul><ul><ul><li>Myocardial Infarction </li></ul></ul><ul><li>CONGESTIVE HEART FAILURE </li></ul><ul><li>HYPERTENSION </li></ul><ul><li>PERIPHERAL VASCULAR DISEASE </li></ul><ul><li>DISORDERS OF THE BLOOD </li></ul>
  • 36. <ul><li>ARTERIOSCLEROTIC HEART DISEASE </li></ul>Plaque formation and internal thickening (intima) Fibrosis and calcification (media) Narrowing and constriction of coronary arteries S/sx of ISCHEMIA
  • 37. ANGINA PECTORIS <ul><li>1. STABLE </li></ul><ul><li>2. UNSTABLE </li></ul><ul><li>3. PRINZMETAL – coronary artery spasm </li></ul><ul><li>4. NOCTURNAL </li></ul><ul><li>5. DECUBITUS </li></ul>
  • 38. 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
  • 39. ANGINA PECTORIS <ul><li>DIAGNOSIS: </li></ul><ul><li>Nitro Test 0.4mg </li></ul><ul><li>NURSING GOALS: </li></ul><ul><li>1. O2 to myocardium </li></ul><ul><li>2. O2 demand </li></ul><ul><li>3. Prevent future episodes of angina </li></ul>
  • 40. O2 to Myocardium : <ul><li>Antiplatelets </li></ul><ul><li>Calcium Blockers </li></ul><ul><li>Beta blockers </li></ul><ul><li>Whisky/Brandy </li></ul><ul><li>Nitrates : </li></ul><ul><li>RAPID-ACTING : </li></ul><ul><li> Nitroglycerine </li></ul><ul><li> Nitrostat </li></ul><ul><li>AmylNitrate </li></ul><ul><li>LONG-ACTING: </li></ul><ul><li> ISDN,ISMN, Nitroglycerine ointment, Transdermal, </li></ul><ul><li> IV </li></ul>
  • 41. O2 Demand <ul><li>Limit activities – CBR </li></ul><ul><li>Moderate Exercise </li></ul><ul><li>Sedatives </li></ul><ul><li>Warmth </li></ul>
  • 42. Prevent Future Episodes <ul><li>DIET – low calorie, low saturated fat </li></ul><ul><li>No tobacco </li></ul><ul><li>Stress Reduction (Anger Management) </li></ul>
  • 43. Coronary Insufficiency <ul><li>IMBALANCE BETWEEN : </li></ul><ul><li>OXYGEN SUPPLY </li></ul><ul><li>OXYGEN DEMAND </li></ul>
  • 44.  
  • 45. MYOCARDIAL INFARCTION <ul><li>IRREVERSIBLE CARDIAC DAMAGE FROM OCCLUSION OF 1 OR MORE CORONARY ARTERY </li></ul><ul><li>REVIEW OF ANATOMY AND PHYSIOLOGY </li></ul><ul><li>E.C.G. </li></ul><ul><li>Recent M.I. – ST elevation (injury) </li></ul><ul><li> T wave inversion (ischemia) </li></ul><ul><li>Previous M.I. – Q wave (necrosis / old infarct) </li></ul><ul><li>BLOOD STUDIES </li></ul><ul><li>Troponin T & I </li></ul><ul><li>LDH </li></ul><ul><li>CPK MB </li></ul>
  • 46. P Q R S T E.C.G.
  • 47. P Q R S T E.C.G. ST SEGMENT ELEVATION
  • 48. P Q R S T E.C.G. INVERTED T - WAVE
  • 49. P Q R S T E.C.G. Q wave
  • 50. MYOCARDIAL INFARCTION <ul><li>NURSING CARE </li></ul><ul><li>1. Pain relief – </li></ul><ul><li>Morphine ( + preload & afterload) </li></ul><ul><li>Demerol causes vomiting </li></ul><ul><li>2. Oxygen </li></ul><ul><li>3. Inotropics </li></ul><ul><li>4. Beta Blockers </li></ul><ul><li>5. Antiarrhythmics </li></ul><ul><li>6. No ice or very hot drinks </li></ul><ul><li>7. Anticoagulants </li></ul><ul><li>8. ECG and CVP monitoring </li></ul><ul><li>9. Laxatives – Lactulose </li></ul><ul><li>10. PTCA </li></ul><ul><li>11. Thrombolytic Therapy </li></ul><ul><li>BEFORE CELLULAR DEATH, US. 6 HRS AFTER THE ATTACK </li></ul>
  • 51. CARDIAC ARRHYTHMIA <ul><li>Review Conduction Pathway </li></ul><ul><li>Review the Basics of Normal ECG </li></ul>
  • 52. CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE
  • 53. P Q R S T E.C.G.
  • 54. CARDIAC ARRHYTHMIA <ul><li>Sinus Tachycardia – P wave precede each QRS >100 bpm </li></ul><ul><li>Sinus Bradycardia – P wave precede each QRS <60 bpm </li></ul><ul><li>Atrial Fibrillation: P wave = f waves; QRS = normal </li></ul>
  • 55. P Q R S T E.C.G.
  • 56. CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE
  • 57. CARDIAC ARRHYTHMIA <ul><li>Premature Ventricular Contraction: P wave normal: early QRS </li></ul><ul><li>Ventricular Tachycardia : 3 or more PVCs </li></ul><ul><li>Asystole – no cardiac activity </li></ul>
  • 58. P Q R S T E.C.G.
  • 59. CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE
  • 60. CARDIAC ARRHYTHMIA <ul><li>Nursing Management </li></ul><ul><ul><li>Oxygen </li></ul></ul><ul><ul><li>Complete Bed Rest </li></ul></ul><ul><ul><li>Cardioversion/ defibrillation </li></ul></ul><ul><ul><li>Administer antiarrhythmics as prescribed: </li></ul></ul><ul><ul><ul><li>Atropine </li></ul></ul></ul><ul><ul><ul><li>Beta blocker- propanolol </li></ul></ul></ul><ul><ul><ul><li>Lidocaine </li></ul></ul></ul><ul><ul><ul><li>Epinephrine </li></ul></ul></ul>
  • 61.  
  • 62. CONGESTIVE HEART FAILURE <ul><li>Review of Anatomy and Physiology </li></ul><ul><li>Backward Failure </li></ul><ul><li>Forward Failure </li></ul><ul><li>Left-Sided </li></ul><ul><li>Right Sided </li></ul><ul><li>Hypermetabolic Failure </li></ul><ul><li>Clinical Manifestations according to: </li></ul><ul><ul><li>Tissue Anoxia </li></ul></ul><ul><ul><li>Pulmonary Hypertension </li></ul></ul><ul><ul><li>Systemic congestion </li></ul></ul>
  • 63. C.H.F. RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION LV
  • 64. CONGESTIVE HEART FAILURE <ul><li>Review of Anatomy and Physiology </li></ul><ul><li>Backward Failure </li></ul><ul><li>Forward Failure </li></ul><ul><li>Left-Sided </li></ul><ul><li>Right Sided </li></ul><ul><li>Hypermetabolic Failure </li></ul><ul><li>Clinical Manifestations according to: </li></ul><ul><ul><li>Tissue Anoxia </li></ul></ul><ul><ul><li>Pulmonary Hypertension </li></ul></ul><ul><ul><li>Systemic congestion </li></ul></ul>
  • 65. CONGESTIVE HEART FAILURE <ul><li>Diagnostics </li></ul><ul><li>Nursing Management </li></ul><ul><ul><li>Goals : </li></ul></ul><ul><ul><li>CARDIAC LOAD </li></ul></ul><ul><ul><ul><li>REST AND SEDATION </li></ul></ul></ul><ul><ul><li>2. CARDIAC CONTRACTILITY </li></ul></ul><ul><ul><ul><li>CHRONOTROPICS – DIGITALIS </li></ul></ul></ul><ul><ul><ul><ul><li>Increase in force of contraction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>monitor serum K, </li></ul></ul></ul></ul><ul><ul><ul><ul><li>C/I if HR </= 60 bpm, </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DIGITALIS TOXICITY </li></ul></ul></ul></ul>
  • 66. CONGESTIVE HEART FAILURE <ul><li>SODIUM REABSORPTION AND FLUID RETENTION </li></ul><ul><li>- DIURETICS ( Thiazide, Loop, K-sparing) </li></ul><ul><li> -measure UO </li></ul><ul><li>-weigh patient </li></ul><ul><li>-watch for s/sx of electrolyte imbalance </li></ul><ul><li>- DIET : Sodium Restricted (0.5gm/day) </li></ul>
  • 67. CONGESTIVE HEART FAILURE <ul><li>4. PREVENTION OF COMPLICATIONS: </li></ul><ul><ul><li>Intractable HF </li></ul></ul><ul><ul><li>Pulmonary edema </li></ul></ul><ul><ul><li>Pulmonary Infarction </li></ul></ul><ul><ul><li>Myocardial Infarction </li></ul></ul><ul><ul><li>Digitalis Toxicity </li></ul></ul><ul><ul><li>Cardiac Arrhythmia </li></ul></ul><ul><ul><li>Pneumonia </li></ul></ul>
  • 68. PULMONARY EDEMA <ul><li>Emergency! </li></ul><ul><li>Fluid into the alveoli, bronchi & bronchioles </li></ul><ul><li>S/SX: </li></ul><ul><li>… of CHF </li></ul><ul><li>Dyspnea </li></ul><ul><li>Cough with pink frothy sputum </li></ul>
  • 69. PULMONARY EDEMA <ul><li>MANAGEMENT: </li></ul><ul><ul><li>Oxygenation </li></ul></ul><ul><ul><li>Assist in Intubation </li></ul></ul><ul><ul><li>Rotating tourniquet </li></ul></ul><ul><ul><li>Phlebotomy </li></ul></ul><ul><ul><li>CVP monitoring </li></ul></ul>
  • 70. HYPERTENSION <ul><li>IN SYSTOLIC PRESSURE >140 </li></ul><ul><li>IN DIASTOLIC PRESSURE > 90 </li></ul><ul><li>CLASSIFICATION : </li></ul><ul><ul><li>PRIMARY </li></ul></ul><ul><ul><ul><li>BENIGN- GRADUAL </li></ul></ul></ul><ul><ul><ul><li>MALIGNANT -ABRUPT ONSET ;SHORT COURSE </li></ul></ul></ul><ul><ul><li>SECONDARY: Renal patho, Adrenal patho, Genetics </li></ul></ul>
  • 71. 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
  • 72. HYPERTENSION <ul><li>Assess for Major CVD Risk Factors </li></ul><ul><li>Assess for Identifiable Causes of Hypertension: </li></ul><ul><ul><li>Sleep apnea </li></ul></ul><ul><ul><li>Drug-Induced related </li></ul></ul><ul><ul><li>Chronic Kidney Disease </li></ul></ul><ul><ul><li>Primary Aldosteronism </li></ul></ul><ul><ul><li>Renovascular Disease </li></ul></ul><ul><ul><li>Cushing’s Syndrome/steroid Therapy </li></ul></ul><ul><ul><li>Pheochromocytoma </li></ul></ul><ul><ul><li>Coarctation of the Aorta </li></ul></ul>
  • 73. HYPERTENSION <ul><li>Diagnostics </li></ul><ul><li>Nursing Care : </li></ul><ul><ul><li>Teach about: modification of Lifestyle, diet, avoidance of stimulants and coffee </li></ul></ul><ul><ul><li>Administer meds as prescribed: ANTIHYPERTENSIVES AND DIURETICS </li></ul></ul><ul><ul><li>Hypertensive Crisis : DIAZOXIDE (Hyperstat), NaNITROPRUSSIDE (Nipride) </li></ul></ul>
  • 74.  
  • 75. PERIPHERAL VASCULAR DISEASE <ul><li>ISCHEMIA OF THE PERIPHERAL VESSELS </li></ul><ul><li>Review of Peripheral Vascular Structures </li></ul><ul><li>Signs and Symptoms of Ischemia </li></ul><ul><ul><li>Coldness </li></ul></ul><ul><ul><li>Pallor </li></ul></ul><ul><ul><li>Rubor </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Pain ( Intermittent Claudication) </li></ul></ul>
  • 76. ISCHEMIA OF THE PERIPHERAL VESSELS <ul><li>Nursing Management </li></ul><ul><li>Increase Arterial Blood Flow or Venous return </li></ul><ul><li>Promote Vasodilation </li></ul><ul><li>Prevent and Treat Vascular Occlusion </li></ul>
  • 77. Increase Arterial Blood Flow or Venous return <ul><li>Proper positioning </li></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><ul><li>Short walks </li></ul></ul></ul><ul><ul><ul><li>Buerger Allen Routine </li></ul></ul></ul><ul><ul><ul><li>Oscillating Bed </li></ul></ul></ul><ul><ul><ul><li>Circoelectric Bed </li></ul></ul></ul>
  • 78. Buerger Allen Routine <ul><li>1. FEET UP , 3 MIN </li></ul><ul><li>2. SIT ON BED & DO FOOT EXERCISE,3 MIN </li></ul><ul><li>3. LIE DOWN 5 MIN </li></ul>
  • 79. Increase Arterial Blood Flow or Venous return <ul><ul><li>Patient education </li></ul></ul><ul><ul><ul><li>Decrease wieght </li></ul></ul></ul><ul><ul><ul><li>Avoid prolonged standing </li></ul></ul></ul><ul><ul><ul><li>Never wear constricting garments </li></ul></ul></ul><ul><ul><ul><li>Never cross legs </li></ul></ul></ul>
  • 80. Promote Vasodilation <ul><ul><li>Warmth </li></ul></ul><ul><ul><li>No nicotine </li></ul></ul><ul><ul><li>Vasodilators : papaverine HCl, vasodilan </li></ul></ul><ul><ul><li>Moderate alcohol </li></ul></ul><ul><ul><li>sympathectomy </li></ul></ul>
  • 81. Prevent and Treat Vascular Occlusion <ul><li>- avoid prolonged bedrest </li></ul><ul><li>-increase fluids </li></ul><ul><li>-proper positions </li></ul><ul><li>-anticoagulant therapy & fibrinolytics </li></ul><ul><li>Heparin - APTT- Protamine SO4 </li></ul><ul><li>Dicumarol- PT - Vit K </li></ul>
  • 82. ARTERIAL DISEASE <ul><li>ARTERIOSCLEROSIS OBLITERANS – LATE STAGE OF ATHEROSCLEROSIS WITH PARTIAL OR COMPLETE OCCLUSION BY ATHEROMA WITH THROMBOSIS </li></ul><ul><li>RAYNAUD’S DISEASE – PERIODIC SPASM OF THE ARTERIES </li></ul><ul><li>ANEURYSMS – LOCALIZED OR DIFFUSED ARTERIAL DILATION </li></ul><ul><li>EMBOLUS/THROMBUS </li></ul>
  • 83. VENOUS DISEASE <ul><li>THROMBOPHLEBITIS – </li></ul><ul><ul><li>INFLAMMATION OF THE VEIN WITH CLOT FORMATION </li></ul></ul><ul><ul><li>HOMAN’S SIGN </li></ul></ul><ul><li>PHLEBOTHROMBOSIS </li></ul><ul><ul><li>CLOTS WITHOUT INFLAMMATION </li></ul></ul><ul><li>VARICOSE VEINS </li></ul><ul><ul><li>TRENDELENBERG’S TEST – NORMAL VEIN FILLS FROM BELOW </li></ul></ul>
  • 84. DISEASE OF ARTERIES AND VEINS <ul><li>BUERGER’S DSE / Thromboangitis Obliterans </li></ul><ul><ul><li>RECURRING INFLAMMATION OF ARTERIES & VEINS </li></ul></ul><ul><ul><li>SMOKING </li></ul></ul><ul><ul><li>INTERMITTENT CLAUDICATION </li></ul></ul><ul><li>A-V FISTULA </li></ul><ul><ul><li>ABN COMMUNICATION BETWEEN A. & V. </li></ul></ul><ul><ul><li>TRAUMATIC/ CONGENITAL </li></ul></ul><ul><ul><li>BRUIT </li></ul></ul>
  • 85. NURSING CARE OF PATIENTS WITH AMPUTATION <ul><li>Control Bleeding – Bandage </li></ul><ul><li>Prevent Edema – elevate 1 st 24 hrs </li></ul><ul><li>Relieving Phantom Limb Pain – hypnosis, destruction </li></ul><ul><li>Assume Body Alignment – Prone 30 min 2x a day to prevent flexion contracture ; AKA – HIP FLEXION AND ABDUCTION, EXTERNAL ROTATION BKA – KNEE FLEXION </li></ul>
  • 86. NURSING CARE OF PATIENTS WITH AMPUTATION <ul><ul><ul><li>Trochanter roll against the hip along the outer side to prevent outward rotation </li></ul></ul></ul><ul><li>Preparing for Locomotion </li></ul><ul><ul><li>Stump care : wash with soap and water only </li></ul></ul><ul><ul><li>Exercise : quad setting, isometric </li></ul></ul><ul><ul><li>Crutch walking : weight- palms, stairs : GOOD LEG FIRST TO HEAVEN; BAD LEG FIRST TO HELL </li></ul></ul>
  • 87. <ul><li>The acute nursing management of a client with CHF will include all of the following goals except: </li></ul><ul><li>Increase in cardiac output </li></ul><ul><li>Elevation in renal blood flow </li></ul><ul><li>Reduction in the heart’s workload </li></ul><ul><li>Decrease in myocardial contractility </li></ul>
  • 88. end of cardiovascular system
  • 89.  
  • 90. Hematologic System
  • 91. REVIEW OF ANATOMY AND PHYSIOLOGY – Blood and Lymphatics <ul><li>Composition of the blood </li></ul><ul><ul><ul><li>RBC, WBC, Platelets, Plasma </li></ul></ul></ul><ul><li>RBC </li></ul><ul><ul><ul><li>normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt; </li></ul></ul></ul><ul><ul><ul><li>HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer </li></ul></ul></ul><ul><li>WBC </li></ul><ul><ul><ul><li>granulocytes –neutrophils, eosinophils, basophils </li></ul></ul></ul><ul><ul><ul><li>agaranulocytes –lymphocytes (T,B), monocytes </li></ul></ul></ul><ul><li>Plasma </li></ul><ul><ul><ul><li>albumin, water, clotting factors, antibodies </li></ul></ul></ul>
  • 92. REVIEW OF ANATOMY AND PHYSIOLOGY – Blood and Lymphatics <ul><li>Role of the Bone Marrow </li></ul><ul><ul><li>Production of all blood components </li></ul></ul><ul><li>Major Roles of the Blood </li></ul><ul><ul><li>homeostasis </li></ul></ul><ul><ul><li>transport of nutrients and electrolytes </li></ul></ul><ul><ul><li>distribute hormones and electrolytes </li></ul></ul><ul><li>Major Role of Lymphatics </li></ul><ul><ul><li>brings back blood to the circulation </li></ul></ul><ul><ul><li>immune antibody production </li></ul></ul>
  • 93. HEMATOLOGIC DISTURBANCES <ul><li>DISORDERS OF THE BLOOD </li></ul><ul><ul><li>RBC : IDA, PERNICIOUS ANEMIA, APLASTIC ANEMIA, HEMOLYTIC ANEMIA, POLYCYTHEMIA VERA </li></ul></ul><ul><ul><li>WBC and Plasma Cell : LEUKEMIA, MULTIPLE MYELOMA </li></ul></ul><ul><ul><li>Lymph Nodes and Spleen : LYMPHOMA, INFECTIOUS MONONUCLEOSIS, SPLENIC RUPTURE, HYPERSPLENISM </li></ul></ul><ul><ul><li>Hemorrhagic Disorders : PURPURA </li></ul></ul><ul><ul><li>Altered Coagulation : HEMOPHILIA, HYPOPROTHROMBINEMIA, D.I.C. </li></ul></ul>
  • 94. HEMATOLOGIC DISTURBANCES <ul><li>RBC : </li></ul><ul><li>IDA </li></ul><ul><li>PERNICIOUS ANEMIA </li></ul><ul><li>APLASTIC ANEMIA </li></ul><ul><li>HEMOLYTIC ANEMIA </li></ul><ul><li>POLYCYTHEMIA VERA </li></ul>
  • 95. NUTRITIONAL ANEMIA <ul><li>IRON DEFICIENCY ANEMIA </li></ul><ul><li>PERNICIOUS ANEMIA </li></ul>
  • 96. IRON DEFICIENCY ANEMIA <ul><li>Composition of the blood </li></ul><ul><ul><ul><li>RBC, WBC, Platelets, Plasma </li></ul></ul></ul><ul><li>RBC </li></ul><ul><ul><ul><li>normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt; </li></ul></ul></ul><ul><ul><ul><li>HEMOBGLOBIN : IRON ; Oxygen transport; Acid-base buffer </li></ul></ul></ul><ul><li>WBC </li></ul><ul><ul><ul><li>granulocytes –neutrophils, eosinophils, basophils </li></ul></ul></ul><ul><ul><ul><li>agaranulocytes –lymphocytes (T,B), monocytes </li></ul></ul></ul><ul><li>Plasma </li></ul><ul><ul><ul><li>albumin, water, clotting factors, antibodies </li></ul></ul></ul>
  • 97. IRON DEFICIENCY ANEMIA <ul><li>HEMOGLOBIN LEVEL FALLS BELOW NORMAL </li></ul><ul><li>CAUSES: </li></ul><ul><li>Poor intake if iron rich foods </li></ul><ul><li>Poor absorption & utilization of iron from foods </li></ul><ul><li>Acute / chronic blood loss </li></ul>
  • 98. Poor intake if iron rich foods <ul><li>increased requirement : </li></ul><ul><ul><li>infants after 6 mos, </li></ul></ul><ul><ul><li>children & adolescents </li></ul></ul><ul><ul><li>women of reproductive age </li></ul></ul><ul><ul><li>pregnant & nursing women </li></ul></ul><ul><li>Erroneous food practices </li></ul><ul><li>Respiratory & GI conditions </li></ul><ul><li>Substandard living condition </li></ul>
  • 99. IRON DEFICIENCY ANEMIA <ul><li>CAUSES: </li></ul><ul><li>Poor intake if iron rich foods </li></ul><ul><li>Poor absorption & utilization of iron from foods </li></ul><ul><li>Acute / chronic blood loss </li></ul>
  • 100. Poor absorption & utilization of iron from foods <ul><li>Form of Iron- </li></ul><ul><li> hemosiderin: from animal food </li></ul><ul><li>more readily absorbed than from plants (nonheme iron) </li></ul><ul><li>Effects of other foods </li></ul><ul><ul><li>inhibit absorption of iron: </li></ul></ul><ul><ul><ul><li>tea, unpolished rice, veges: bulaklak ng kalabasa, sampalok, mustasa </li></ul></ul></ul>
  • 101. Poor absorption & utilization of iron from foods <ul><li>Host factors : </li></ul><ul><ul><li>poor iron absorption in: </li></ul></ul><ul><ul><ul><li>severe protein-energy malnutrition & repeated diarrhea </li></ul></ul></ul><ul><ul><ul><li>Infections </li></ul></ul></ul><ul><ul><ul><li>Delibitating disease </li></ul></ul></ul>
  • 102. IRON DEFICIENCY ANEMIA <ul><li>CAUSES: </li></ul><ul><li>Poor intake if iron rich foods </li></ul><ul><li>Poor absorption & utilization of iron from foods </li></ul><ul><li>Acute / Chronic blood loss </li></ul>
  • 103. Acute / Chronic blood loss <ul><li>Acute hemorrhage </li></ul><ul><li>Chronic or repeated Blood loss: </li></ul><ul><ul><li>WHIPWORM </li></ul></ul><ul><ul><ul><li>0.005 ML OF BLOOD PER WORM PER DAY </li></ul></ul></ul><ul><ul><li>HOOKWORM </li></ul></ul><ul><ul><ul><li>0.2 ML OF BLOOD PER WORM PER DAY </li></ul></ul></ul><ul><ul><li>SCHISTOSOMIASIS </li></ul></ul><ul><ul><li>MALARIA </li></ul></ul><ul><ul><li>PEPTIC ULCER </li></ul></ul><ul><ul><li>EXCESSIVE MENSTRUAL FLOW </li></ul></ul>
  • 104. IRON DEFICIENCY ANEMIA <ul><li>CLINICAL FEATURES: </li></ul><ul><li>Asymptomatic </li></ul><ul><ul><li>inability to respond to increased iron demand </li></ul></ul><ul><li>Normal Hgb levels but with s/sx : </li></ul><ul><ul><li>lack of energy, fatiguability, reduced power and concentration </li></ul></ul><ul><li>Severe anemia : </li></ul><ul><ul><li>difficulty in breathing, </li></ul></ul><ul><ul><li>palpitation, </li></ul></ul><ul><ul><li>headache, </li></ul></ul><ul><ul><li>faintness </li></ul></ul><ul><ul><li>loss of appetite </li></ul></ul>
  • 105. IRON DEFICIENCY ANEMIA <ul><li>ASSESSMENT: </li></ul><ul><li> Lab: </li></ul><ul><li>DECREASED HEMOGLOBIN & HEMATOCRIT LEVEL </li></ul><ul><li>MICROCYTIC, HYPOCHROMIC RBC </li></ul><ul><li>DECREASED RETICULOCYTE COUNT </li></ul><ul><li>Clinical Method </li></ul><ul><li>HISTORY </li></ul><ul><li>CLINICAL EXAMINATION - PALLOR </li></ul>
  • 106. IRON DEFICIENCY ANEMIA <ul><li>TREATMENT: </li></ul><ul><li>IRON ADMINISTRATION: </li></ul><ul><li>ORAL </li></ul><ul><ul><li>ADULT : 100-120 mg/day </li></ul></ul><ul><ul><li>INFANTS AND CHILDREN : 3mg/kg/day </li></ul></ul><ul><li>PARENTERAL IRON DEXTRAN </li></ul><ul><ul><li>IM : 250 MG FOR EACH gm% LOWER THAN THE NORMAL VALUE </li></ul></ul><ul><ul><li>IV: 100-300 mg in 500ml SALINE SOLUTION </li></ul></ul>
  • 107. ORAL IRON ADMINISTRATION <ul><li>ABSORPTION : </li></ul><ul><li>GREATEST DURING THE FIRST MONTH OF TX, AND DECREASES WHEN IRON STORES ARE INCREASING </li></ul><ul><li>EMPTY STOMACH: GOOD ABSORPTION, MORE G.I. S/E </li></ul><ul><li>ADMINISTER DURING OR PC </li></ul><ul><li>ASCORBIC ACID </li></ul><ul><li>BETTER ABSORBED IN FERROUS THAN IN FERRIC FORM </li></ul><ul><li>FERROUS SULFATE IS THE CHEAPEST AND READILY ABSORBABLE FORM </li></ul><ul><li>DOSE: CALCULATE THE ELEMENTAL IRON </li></ul><ul><ul><ul><ul><li>FERROUS SULFATE HAS 36.74% ELEMENTAL IRON </li></ul></ul></ul></ul>
  • 108. ORAL IRON ADMINISTRATION <ul><li>DURATION: </li></ul><ul><li>2 MOS, ANEMIA IS ALREADY ALLEVIATED </li></ul><ul><li>5 MOS, FOR IRON STORES </li></ul><ul><li>PREGNANT : 24 TH WK TO TERM </li></ul><ul><li>SIDE EFFECTS: </li></ul><ul><li>CONSTIPATION/DIARRHEA </li></ul><ul><li>NAUSEA </li></ul><ul><li>EPIGASTRIC PAIN / HEART BURN </li></ul>
  • 109. PARENTERAL IRON ADMINISTRATION <ul><li>INDICATIONS: </li></ul><ul><li>SEVERE DEFICIENCY </li></ul><ul><li>ORAL PREPARATIONS FAIL </li></ul><ul><li>CONDITION DO NOT PERMIT ORAL ADMINISTRATION </li></ul><ul><li>ABSORPTION: </li></ul><ul><li>RAPID </li></ul><ul><li>THERAPEUTIC RESPONSE </li></ul><ul><li>SAME WITH ORAL </li></ul>
  • 110. PARENTERAL IRON ADMINISTRATION <ul><li>ADVANTAGE: </li></ul><ul><li>S/E ARE AVOIDED </li></ul><ul><li>PROBLEMS WITH ABSORPTION IS AVOIDED </li></ul><ul><li>DISADVANTAGE: </li></ul><ul><li>COSTLY </li></ul><ul><li>TOXICITY IS POSSIBLE </li></ul><ul><li>ALLERGIC REACTION </li></ul>
  • 111. PARENTERAL IRON ADMINISTRATION <ul><li>PRECAUTION: </li></ul><ul><li>GIVEN UNDER CLOSE SUPERVISION BY PHYSICIAN </li></ul><ul><li>Z-TRACK METHOD </li></ul><ul><li>TISSUE STAINING & IRRITATION </li></ul>
  • 112. IRON TOXICITY <ul><li>VERY RARE IN ORAL </li></ul><ul><li>SIDEROSIS </li></ul><ul><ul><li>HEMOSIDERIN IN TISSUES </li></ul></ul><ul><li>HEMOCHROMATOSIS </li></ul><ul><ul><li>END POINT OF SIDEROSIS, </li></ul></ul><ul><ul><li>DAMAGE TO LIVER AND PANCREAS </li></ul></ul><ul><li>PREVENTION: </li></ul><ul><ul><li>ADMIN IN DIVIDED DOSES </li></ul></ul><ul><ul><li>KEEP OUT OF CHILDREN’S REACH </li></ul></ul>
  • 113. MEASURES TO MINIMIZE IRON REQUIREMENTS <ul><li>PARASITE CONTROL </li></ul><ul><ul><li>ADMINISTER MEDS FOR PARASITISM </li></ul></ul><ul><ul><li>MINIMIZE RISK OF REINFESTATION: </li></ul></ul><ul><ul><ul><li>REGULAR DEWORMING – EVERY 4-6 MOS </li></ul></ul></ul><ul><ul><ul><li>FOOTWEAR </li></ul></ul></ul><ul><ul><ul><li>PROPER USE OF LATRINE </li></ul></ul></ul><ul><li>FAMILY PLANNING </li></ul><ul><ul><li>DECREASE THE # OF PREGNANCIES AND DELIVERIES </li></ul></ul><ul><ul><li>IUD – INCREASED MENSTRUAL LOSSES </li></ul></ul><ul><li>POST-DELIVERY MEASURES </li></ul><ul><ul><li>LATCH ON – OXYTOCIN RELEASE </li></ul></ul><ul><ul><li>CUT THE CORD AFTER PULSATION STOPS </li></ul></ul>
  • 114. MEASURES TO DIRECTLY AUGMENT IRON STORES <ul><li>SUPLEMENTATION </li></ul><ul><ul><li>PREGNANT 24 WKS TO TERM </li></ul></ul><ul><ul><li>NURSING MOTHERS </li></ul></ul><ul><ul><li>MALNOURISHED INFANTS & PRESCHOOLERS </li></ul></ul><ul><ul><li>PRETERM INFANTS </li></ul></ul><ul><li>FORTIFICATION </li></ul><ul><li>EDUCATION </li></ul>
  • 115. Burger King guest
  • 116. PERNICIOUS ANEMIA <ul><li>REVIEW OF ANATOMY & PHYSIOLOGY : STOMACH </li></ul><ul><li>Stores and mixes food with gastric juices & mucus producing chemical & mechanical changes in the bolus of food </li></ul><ul><li>Sphincters: cardiac and pyloric </li></ul><ul><li>Divisions: fundus, body, antrum </li></ul><ul><li>Secretions: </li></ul><ul><ul><li>Pepsinogen : by chief cells </li></ul></ul><ul><ul><li>HCl: by parietal cells </li></ul></ul><ul><ul><li>Intrinsic factor : by parietal cells </li></ul></ul><ul><ul><li>mucoid </li></ul></ul>
  • 117. PERNICIOUS ANEMIA <ul><li>Composition of the blood </li></ul><ul><ul><ul><li>RBC, WBC, Platelets, Plasma </li></ul></ul></ul><ul><li>RBC </li></ul><ul><ul><ul><li>normal erythropoeisis requires : pyridoxine, Vitamin B12 , folic acid, protein, copper, cobalt; </li></ul></ul></ul><ul><ul><ul><li>HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer </li></ul></ul></ul><ul><li>WBC </li></ul><ul><ul><ul><li>granulocytes –neutrophils, eosinophils, basophils </li></ul></ul></ul><ul><ul><ul><li>agaranulocytes –lymphocytes (T,B), monocytes </li></ul></ul></ul><ul><li>Plasma </li></ul><ul><ul><ul><li>albumin, water, clotting factors, antibodies </li></ul></ul></ul>
  • 118. 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
  • 119. PERNICIOUS ANEMIA <ul><li>OTHER TISSUES AFFECTED BY VIT B12 DEFICIENCY: </li></ul><ul><li>MOUTH </li></ul><ul><li>STOMACH </li></ul><ul><li>VAGINA </li></ul><ul><li>MYELIN SHEATH </li></ul>
  • 120. PERNICIOUS ANEMIA <ul><li>S/SX: </li></ul><ul><li>WEAKNESS, FATIGUE, PALLOR, JAUNDICE </li></ul><ul><li>SORE MOUTH, SMOOTH BEEFY TONGUE </li></ul><ul><li>ATROPHY OF THE GASTRIC MUCOSA </li></ul><ul><li>PERIPHERAL NERVE DEGENERATION : TINGLING, NUMBNESS OF HANDS AND FEET </li></ul><ul><li>LOSS OF COORDINATION, +ROMBERG’S </li></ul>
  • 121. PERNICIOUS ANEMIA <ul><li>DIAGNOSIS: </li></ul><ul><li>PERIPHERAL SMEAR : MACROCYTIC CELLS </li></ul><ul><li>(+) ROMBERG’S </li></ul><ul><li>GASTRIC ANALYSIS </li></ul><ul><ul><li>(diagnex blue test) – ACHLORHYDRIA from thinning of mucosa – HCl is also produced by parietal cells of the stomach </li></ul></ul><ul><li>SCHILLING’S TEST – B12 IN 24 HRS URINE SPEC </li></ul>
  • 122. SCHILLING’S TEST <ul><li>DEFINITIVE TEST FOR PERNICIOUS ANEMIA </li></ul><ul><li>DETECT LACK OF INTRINSIC FACTOR </li></ul><ul><li>MEASURES ABSORPTION OF RADIOACTIVE VIT B12 BOTH BEFORE & AFTER PARENTERAL ADMINISTRATION OF INTRINSIC FACTOR </li></ul><ul><li>FASTING CLIENT IS GIVEN RADIOACTIVE VIT B12 BY MOUTH AND NONRADIOACTIVE VIT B12 IM </li></ul>
  • 123. SCHILLING’S TEST <ul><li>24-48 HR URINE OBTAINED & TESTED FOR VIT B 12 </li></ul><ul><li>AFTER 1 WK, FASTING CLIENT IS GIVEN RADIOACTIVE VIT B 12 ORALLY WITH PARENTERAL HUMAN INTRINSIC FACTOR </li></ul><ul><li>URINE TEST IS REPEATED </li></ul>
  • 124. PERNICIOUS ANEMIA <ul><li>MANAGEMENT: </li></ul><ul><li>NO CURE; VIT B12 IM FOR LIFE </li></ul><ul><li>DIET: MEAT & DAIRY </li></ul><ul><li>HCL : </li></ul><ul><ul><li>1 ST WK; </li></ul></ul><ul><ul><li>DILUTE WITH WATER; </li></ul></ul><ul><ul><li>ADMINISTER WITH STRAW </li></ul></ul><ul><li>AVOID SEASONED FOODS </li></ul>
  • 125. PERNICIOUS ANEMIA <ul><li>MANAGEMENT: </li></ul><ul><li>MOUTH CARE: SOFT TOOTHBRUSH </li></ul><ul><li>AVOID HEATING PADS – DECREASE IN SENSATION </li></ul><ul><li>AFTER 2-3 DAYS TX, INCREASE IN RETICULOCYTE COUNT </li></ul><ul><li>REHAB & PT FOR NEURODEFICITS </li></ul>
  • 126. APLASTIC ANEMIA <ul><li>DEPRESSION OF ALL BLOOD FORMING ELEMENTS FROM BONE MARROW DESTRUCTION </li></ul><ul><li>IDIOPATHIC </li></ul><ul><li>SECONDARY </li></ul>
  • 127. APLASTIC ANEMIA <ul><li>CAUSE: </li></ul><ul><li>ANTINEOPLASTIC DRUGS & RADIATION </li></ul><ul><li>IMMUNOSUPPRESIVE DRUGS </li></ul><ul><li>CHLORAMPHENICOL </li></ul><ul><li>SULFONAMIDES </li></ul><ul><li>TOXIC SUBSTANCES: BENZENE ,DDT, THIAZIDE, DIURETICS GOLD </li></ul>
  • 128. APLASTIC ANEMIA <ul><li>ASSESSMENT : </li></ul><ul><li>S/SX OF ANEMIA </li></ul><ul><li>INCREASED SUSCEPTIBILITY TO INFECTION </li></ul><ul><li>BLEEDING TENDENCIES & HEMORRHAGE </li></ul>
  • 129. APLASTIC ANEMIA <ul><li>LAB: </li></ul><ul><li>NORMOCYTIC ANEMIA </li></ul><ul><li>GRANULOCYTOPENIA </li></ul><ul><li>THROMBOCYTOPENIA </li></ul><ul><li>BONE MARROW BIOPSY: </li></ul><ul><li>FATTY </li></ul><ul><li>VERY FEW DEVELOPING CELLS </li></ul>
  • 130. HEMOLYTIC ANEMIA EXCESSIVE RBC DESTRUCTION <ul><li>CAUSES: </li></ul><ul><li>ACQUIRED </li></ul><ul><ul><li>SNAKE VENOM </li></ul></ul><ul><ul><li>BURNS </li></ul></ul><ul><ul><li>BT INCOMPATIBILITY </li></ul></ul><ul><ul><li>MALARIA </li></ul></ul><ul><ul><li>TOXOPLASMOSIS </li></ul></ul><ul><li>CONGENITAL </li></ul><ul><ul><li>HEREDITARY SPHEROCYTOSIS </li></ul></ul><ul><ul><li>G6PD DEFICIENCY </li></ul></ul><ul><ul><li>THALASSEMIA </li></ul></ul><ul><ul><li>SICKLE CELL </li></ul></ul>
  • 131. POLYCYTHEMIA <ul><li>INCREASE IN CIRCULATING BLOOD CELLS IN THE BLOOD DUE TO BONE MARROW OVERGROWTH </li></ul><ul><li>FORMS: </li></ul><ul><li>POLYCYTHEMIA VERA </li></ul><ul><li>SECONDARY POLYCYTHEMIA </li></ul><ul><li>RELATIVE POLYCYTHEMIA </li></ul>
  • 132. POLYCYTHEMIA <ul><li>ASSESSMENT : </li></ul><ul><li>RUDDY COMPLEXION </li></ul><ul><li>HYPERTENSION </li></ul><ul><li>SYMPTOMS OF CHF </li></ul><ul><li>THROMBUS FORMATION </li></ul><ul><li>BLEEDING </li></ul><ul><li>HEPATOSPLENOMEGALY </li></ul><ul><li>GOUT </li></ul><ul><li>PHLEBOTOMY </li></ul>
  • 133. CLINICAL CARE OF PATIENTS WITH ANEMIA <ul><li>REST </li></ul><ul><li>SKIN CARE </li></ul><ul><ul><li>DECUBITUS ULCER FROM CELL HYPOXIA </li></ul></ul><ul><li>DIET </li></ul><ul><ul><li>6 SMALL EASILY DIGESTIBLE MEALS </li></ul></ul><ul><ul><li>NO HOT & SPICY FOODS </li></ul></ul><ul><li>MOUTH CARE </li></ul><ul><li>TRANSFUSION NOT A ROUTINE </li></ul><ul><li>OXYGEN </li></ul>
  • 134. CLINICAL CARE OF PATIENTS WITH ANEMIA <ul><li>PROTECTION FROM INJURY </li></ul><ul><ul><li>BURNS and CHILLING </li></ul></ul><ul><li>ISLOLATION BY: </li></ul><ul><ul><li>REVERSE ISOLATION </li></ul></ul><ul><ul><li>LIFE ISLAND- BED ENCLOSED IN PLASTIC CANOPY </li></ul></ul><ul><ul><li>LAMIANR AIRFLOW LIMIT – UNIT WITH MICROFILTER </li></ul></ul>
  • 135. Don’t look at me…
  • 136. HEMATOLOGIC DISTURBANCES <ul><li>WBC and Plasma Cell : </li></ul><ul><li>LEUKEMIA </li></ul><ul><li>MULTIPLE MYELOMA </li></ul>
  • 137. LEUKEMIA <ul><li>FATAL NEOPLASTIC DISEASE THAT INVOLVES THE BLOOD FORMING TISSUES OF THE: </li></ul><ul><ul><li>BONE MARROW </li></ul></ul><ul><ul><li>SPLEEN </li></ul></ul><ul><ul><li>LYMPH NODES </li></ul></ul><ul><li>UNCONTROLLED & DESTRUCTIVE PROLIFERATION OF ONE TYPE OF WBC & ITS PRECURSORS </li></ul>
  • 138. LEUKEMIA <ul><li>INFILTRATE: </li></ul><ul><ul><li>LIVER </li></ul></ul><ul><ul><li>SKIN </li></ul></ul><ul><ul><li>KIDNEYS </li></ul></ul><ul><ul><li>LYMPH TISSUES </li></ul></ul><ul><li>TYPES: </li></ul><ul><li>MYELOGENOUS </li></ul><ul><li>LYMPHOCYTIC </li></ul>
  • 139. LEUKEMIA <ul><li>S/SX: </li></ul><ul><ul><li>ANEMIA </li></ul></ul><ul><ul><li>THROMBOCYTOPENIA </li></ul></ul><ul><ul><li>INFECTION </li></ul></ul><ul><ul><li>PETECHIAE </li></ul></ul><ul><ul><li>HEPATOSPLENOMEGALY & LYMPH NODE ENLARGEMENT </li></ul></ul><ul><ul><li>ARTHRALGIA & BONE PAIN FROM EXPANSION OF BM </li></ul></ul>
  • 140. LEUKEMIA <ul><li>LAB: </li></ul><ul><li>INCREASED WBC </li></ul><ul><li>ANEMIA </li></ul><ul><li>THROMBOCYTOPENIA </li></ul><ul><li>INCREASE ALKALINE PHOSPHATASE </li></ul><ul><ul><li>OSTEOBLASTIC ACTIVITY </li></ul></ul><ul><li>BONE MARROW BIOPSY </li></ul>
  • 141. LEUKEMIA – NURSING CARE <ul><li>PROVIDE ADEQUATE REST INCREASED METABOLIC RATE FROM OVERPRODUCTION OF LEUKOCYTES </li></ul><ul><li>PAIN CONTROL ASA, CODEINE, DEMEROL </li></ul><ul><li>ADEQUATE FOOD & FLUID INTAKE HIGH CALORIE DIET VITAMIN SUPPLEMENTS 3-4 L OF FLUID PER DAY </li></ul>
  • 142. LEUKEMIA – NURSING CARE <ul><li>MOUTH CARE H2O2 LEMON & GLYCERINE </li></ul><ul><li>PREVENT INFECTION PROTECT PATIENT FROM HIS OWN FLORA – NEOMYCIN </li></ul><ul><li>CHEMOTHERAPY </li></ul><ul><ul><li>GOAL- INDUCTION OF COMPLETE REMISSION </li></ul></ul><ul><ul><li>TOLERABLE LEVEL OF TOXICITY – CRITERION FOR LIMITATION OF INDUCTION PHASE </li></ul></ul>
  • 143. MULTIPLE MYELOMA <ul><li>MOST COMMON NEOPLASTIC DISORDER OF THE PLASMA CELL </li></ul><ul><li>BONE MARROW MALIGNANCY </li></ul><ul><li>REVIEW OF PLASMA CELL AND ITS PRODUCTS </li></ul><ul><li>S/SX: </li></ul><ul><ul><li>BACK PAIN, </li></ul></ul><ul><ul><li>FATIGUE, WEIGHT LOSS, </li></ul></ul><ul><ul><li>OSTEOPOROSIS </li></ul></ul><ul><ul><li>HYPERCALCEMIA </li></ul></ul>
  • 144. MULTIPLE MYELOMA <ul><li>LABS: </li></ul><ul><ul><li>BLOOD: DECREASED WBC, HGB & PLATELET; INCREASED SERUM INMMUNEGLOBULINS </li></ul></ul><ul><li>RADIOLOGY </li></ul><ul><ul><li>DIFFUSE BONE LESIONS </li></ul></ul><ul><li>DIAGNOSIS: BENCE-JONES PROTEIN GLOBULIN IN THE URINE </li></ul>
  • 145. HEMATOLOGIC DISTURBANCES <ul><li>Lymph Nodes and Spleen : </li></ul><ul><ul><li>LYMPHOMA </li></ul></ul><ul><ul><li>INFECTIOUS MONONUCLEOSIS </li></ul></ul><ul><ul><li>SPLENIC RUPTURE </li></ul></ul><ul><ul><li>HYPERSPLENISM </li></ul></ul>
  • 146. LYMPHOMA <ul><li>HODGKIN’S & NON HODGKIN’S DISEASE </li></ul><ul><li>LYMPHOSARCOMA </li></ul><ul><li>BURKITT’S LYMPHOMA </li></ul>
  • 147. <ul><li>HODGKIN’S DISEASE </li></ul><ul><li>MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE </li></ul><ul><li>ENLARGEMENT OF THE LYMPH NODES </li></ul><ul><li>NIGHT SWEATS </li></ul><ul><li>BODY MALAISE </li></ul><ul><li>WEIGHT LOSS </li></ul><ul><li>REED-STERNBERG CELLS IN LYMPHNODE BIOPSY </li></ul>
  • 148. NONHODGKIN’S DISEASE <ul><li>MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE </li></ul><ul><li>ENLARGEMENT OF THE LYMPH NODES </li></ul><ul><li>MORE FATAL & DIFFICULT TO CONTROL </li></ul><ul><li>UNDIFFERENTIATED CELLS IN LYMPH NODE BIOPSY </li></ul>
  • 149. INFECTIOUS MONONUCLEOSIS <ul><li>AKA : GLANDULAR / KISSING DSE </li></ul><ul><li>S/SX: </li></ul><ul><li>PAINFUL ENLARGEMENT - LYMPHNODES </li></ul><ul><li>LYMPHOCYTOSIS </li></ul><ul><li>FEVER </li></ul>
  • 150. INFECTIOUS MONONUCLEOSIS <ul><li>CAUSE: EPSTEIN-BARR VIRUS </li></ul><ul><li>CONTACT: KISSING </li></ul><ul><li>DIAGNOSIS : PAUL-BUNNEL HETEROPHIL TEST </li></ul><ul><li>COMPLICATION : SPLENIC RUPTURE </li></ul>
  • 151. SPLENECTOMY <ul><li>INDICATIONS: </li></ul><ul><li>RUPTURE OF THE SPLEEN FROM TRAUMA, INFECTIOUS MONONUCLEOSIS </li></ul><ul><li>HYPERSPLENISM – EXCESSIVE SPLENIC DAMAGE OF CELLULAR BLOOD COMPONENTS </li></ul>
  • 152. SPLENECTOMY <ul><li>NURSING CARE: </li></ul><ul><li>PREOP </li></ul><ul><li>PNEUMOCOCCAL VACCINE </li></ul><ul><li>POSTOP </li></ul><ul><li>MONITOR FOR BLEEDING & SHOCK </li></ul><ul><li>FEVER WITHOUT INFECTION IS COMMON </li></ul><ul><li>PROPHYLACTIC ANTIBIOTIC </li></ul>
  • 153. Hemorrhagic Disorders : PURPURA <ul><li>EXTRAVASATION OF SMALL AMTS OF BLOOD INTO THE TISSUES AND MUCUS MEMBRANE </li></ul><ul><li>VASCULAR PURPURA </li></ul><ul><li>CAUSES : </li></ul><ul><ul><li>HEREDITY </li></ul></ul><ul><ul><li>ALLERGY (HENOCH-SCHONLEIN) </li></ul></ul><ul><ul><li>DRUGS (TOXIC PURPURA) </li></ul></ul><ul><ul><li>POOR NUTRITION </li></ul></ul><ul><ul><li>INFECTION </li></ul></ul><ul><ul><li>HPN </li></ul></ul><ul><li>THROMBOCYTOPENIC PURPURA </li></ul>
  • 154. Disorders of Altered Coagulation <ul><ul><li>HEMOPHILIA </li></ul></ul><ul><ul><li>HYPOPROTHROMBINEMIA </li></ul></ul><ul><ul><li>D.I.C. </li></ul></ul>
  • 155. HEMOPHILIA <ul><ul><li>Deficit in one of the clotting factors </li></ul></ul><ul><ul><li>A – Factor VIII </li></ul></ul><ul><ul><li>B - Factor IX </li></ul></ul><ul><ul><li>C- Factor XI </li></ul></ul>
  • 156. HEMOPHILIA <ul><ul><li>S/SX: </li></ul></ul><ul><ul><li>PROLONGED BLEEDING AFTER MINOR INJURY: </li></ul></ul><ul><ul><ul><li>CUTTING OF CORD </li></ul></ul></ul><ul><ul><ul><li>CIRCUMCISION </li></ul></ul></ul><ul><ul><ul><li>IMMUNIZATION </li></ul></ul></ul><ul><ul><li>HEMARTHROSIS </li></ul></ul><ul><ul><li>PERIPHERAL NEUROPATHY – BLEEDING NEAR PERIPHERAL NERVES </li></ul></ul><ul><ul><li>LAB: </li></ul></ul><ul><ul><li>PROLONGED PTT </li></ul></ul><ul><ul><li>NORMAL PLT CT </li></ul></ul><ul><ul><li>ANEMIA </li></ul></ul>
  • 157. HYPOPROTHROMBINEMIA <ul><li>LIVER FAILURE </li></ul><ul><li>BLEEDING EPISODES </li></ul><ul><li>VITAMIN K </li></ul>
  • 158. D.I.C. <ul><li>2 CONFLICTING SETS OF MANIFESTATIONS: </li></ul><ul><li>DIFFUSE FIBRIN DEPOSITION WITHIN ARTERIOLES AND CAPILLARIES THROUGHOUT THE BODY </li></ul><ul><li>BLEEDING INTO THE KIDNEYS, BRAIN, ADRENAL, HEART AND OTHER ORGANS </li></ul>
  • 159. D.I.C. DIFFUSE FIBRIN DEPOSITION WIHIN ARTERIOLES AND CAPILLARIES WIDESPREAD CLOTTING DEPLETION OF CLOTTING FACTORS
  • 160. D.I.C. <ul><li>CAUSE: </li></ul><ul><li>UNKNOWN </li></ul><ul><li>CRITICAL ILLNESS: </li></ul><ul><ul><li>TOXEMIA OF PREGNANCY </li></ul></ul><ul><ul><li>CANCER </li></ul></ul><ul><ul><li>SURGICAL PROBLEMS </li></ul></ul><ul><ul><li>HEMOLYTIC DSE </li></ul></ul><ul><li>ASSESMENT: </li></ul><ul><li>PETECHIAE, ECCHYMOSIS </li></ul><ul><li>PROLONGED BLEEDING </li></ul><ul><li>ARF </li></ul><ul><li>CONVULSIONS </li></ul><ul><li>COMA </li></ul><ul><li>LAB: </li></ul><ul><li>FIBRIN SPLIT PRODUCTS </li></ul>
  • 161. A.I.D.S. <ul><li>Severe deficit in cellular immune functions </li></ul><ul><li>HIV virus- infects T helper cells </li></ul><ul><li>Transmission </li></ul><ul><li>Antiretroviral drugs </li></ul><ul><li>Assessment: </li></ul><ul><ul><li>Flulike s/sx </li></ul></ul><ul><ul><li>Hypoxemia from pulm infection </li></ul></ul><ul><ul><li>Progressive weight loss </li></ul></ul><ul><ul><li>Temp elevations; night sweats </li></ul></ul><ul><ul><li>Neurologic dyfxn </li></ul></ul><ul><ul><li>Opportunistic infections </li></ul></ul><ul><li>Laboratory : </li></ul><ul><ul><li>ELISA </li></ul></ul><ul><ul><li>Western Blot </li></ul></ul><ul><ul><li>Anemia </li></ul></ul><ul><ul><li>Leukopenia </li></ul></ul><ul><ul><li>thrombocytopenia </li></ul></ul>
  • 162. A.I.D.S. <ul><li>NURSING INTERVENTION: </li></ul><ul><li>Administer meds </li></ul><ul><li>Monitor resp, neurologic, F & E balance </li></ul><ul><li>Monitor nutritional intake </li></ul><ul><li>Inspect oral cavity for ulcerations </li></ul><ul><li>Observe s/sx of infection </li></ul><ul><li>Severe leukopenia – neutropenic precaution </li></ul><ul><li>Blood & body fluid precaution </li></ul><ul><li>Emotional support </li></ul>
  • 163. <ul><li>The nurse should understand that a heparin order for a client with DIC is given to: </li></ul><ul><li>Prevent clot formation </li></ul><ul><li>Increase blood flow to target organs </li></ul><ul><li>Increase clot formation </li></ul><ul><li>Decrease blood flow to target organs </li></ul>
  • 164. GOD BLESS

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