Adult Health Exam 1 Study guide
Ambulatory Surgery - outpatient
Elective Surgery - choice
Emergency Surgery - 911
Informed Consent – Dr gets signature
Same-Day Admission aka Outpatient
Surgery
Anesthesia care provider
Anesthesiology
Epidural block – regional anesthesia
General anesthesia
Local anesthesia aka Regional Anesthesia – block nerves or nerve fibers
Spinal, epidural, caudal, & nerve blocks
Malignant hyperthermia – 1st S/S Tachycardia, skeletal muscle rigidity, anesthesia provide sign is HYPERCARBIA
triggered by volatile gas anesthetic (except nitrous oxide) and/or succinylcholine. NI Dantroline and cooling the
patient.
Nurse anesthetist - CRNA
Spinal anesthesia
Airway obstruction
Atelectasis – complete or partial collapse of the entire LUNG or a LOBE
Delayed Emergence – failure to return to normal after general anesthesia, temporary.
Emergence Delirium – delirium and agitation during recovery after surgery
Fast-Tracking – multi-modal concept to accelerate recovery from anesthesia/surgery
Patient-Controlled Analgesia – pump used by the patient, but is preprogrammed with correct dose and time
Postoperative ileus (POI) impairment of GI motility after intra-abdominal or nonabdominal surgery S/S bowel
distention, lack of bowel sounds, accumulation of GI gas and fluids, and delayed passage of flatus and stool
Rapid Post anesthesia care progression 2.
Apply knowledge of the purpose and components of a preoperative nursing assessment
Age
Allergies and sensitivities to latex
Current meds, OTC meds, vitamins, and herbal supplements
Medical history and tx plans
Surgical hx
Previous anesthesia and responses to anesthesia
Last oral intake
Any medical implants or devices
Piercings, dental implants,
Nutritional deficiencies
Family hx, social hx, smoking, drug and alcohol habits Hx of mental illness or abuse
Support system and living conditions
3.
Advance directives
Identify the major nursing goals for each phase of the perioperative period.
3 PHASES of Perioperative period
Preoperative phase – begins when the decision to have surgery is made, it ends when the client is
transferred to the operating table
Intraoperative phase – begins when the client is transferred to the OR table and ends when the client
is admitted to PACU
Postoperative phase – begins with the clients admission to the postanesthesia area and ends when the
healing is complete
4.
Identify the physical and psychosocial responses of clients to surgery.
5.
Identify and analyze the components of preoperative client preparation.
Lab Assess – type and crossmatch, CBC, renal and liver functions, liver enzymes, albumin, electrolytes, blood urea
nitrogen, and creatinine. Urine for the presence of glucose, blood, protein, and specific gravity and the presence of
keytones
Radiological Assess – sometimes prior to surgery, MRI, CAT scan, sono or x-ray, imaging studies and an ECG
Patient teaching – helps decrease anxiety = improved patient outcomes, PACU procedures, how the family will see
the patient, and discharge information. Questions the family has
Physical Prep –
IV – 18 gauge cath (size for admin of all blood products), LABEL IV with gauge, time, date and nurses initials
Bowel and B ladder – abdominal, intestinal, gyno, or rectal may be asked to do a bowel prep. Enema or
laxatives, may also need a catheter
Skin Prep – betadine or hexachloriphene soap at home or in the hospital room, shave with clippers only,
double check that all body piercings are out at this time
Medications – (see below)
6.
Differentiate the purpose and types of common preoperative medications.
Preoperative anxiety – Benzodiazepines – midazolam HCL, diazepam, or lorazepam
for hx of N/V due to anesthesia - Antiemetics – metoclopramide HCL or ondansetron HCL
7.
Identify nursing diagnoses and interventions that correspond to the intraoperative setting.
8.
Identify complications that may occur during each phase of the perioperative period.
Coughing, deep breathing and
9.
Interpret the significance of data related to the perioperative client’s health status and operative risk.
10. Describe nursing interventions to prevent or treat postoperative complications
11. Describe the nursing role in the psychological and educational preparation of the surgical client.
12. Identify the special considerations of preoperative preparation for the older adult surgical client.
CONTENT OUTLINE - Textbook
I.
II.
III.
IV.
Preoperative phase
Intraoperative phase
Postoperative phase
Pain
Chapter 15 pp. 283 - 300
Chapter 16 pp. 301 - 322
Chapter 17 pp. 323 – 337
Chapter 11 pp. 175-214
LEARNING OPPORTUNITIES
1. Identify and describe the roles of the intraoperative health care team.
2. Develop a plan of care for the postoperative client including common potential postoperative complications.
3. Design a preoperative teaching plan for the client anticipating surgery.
Cardiovascular
Preload – volume of blood in ventricles at the
end of diastole (end diastolic pressure)
increased volume = increased stretch, which
produces increased contraction (Starling’s
Law) *****increases in MI, aortic stenosis, and
hypervolemia***
Afterload - resistance to flow the ventricle must
overcome to open the semilunar valves and eject
its contents. This is related to BP, vessel lumen
diameter, and/or vessel compliance. The valves
can meet resistance on both the right and left
through the pulmonary artery or aorta.
Hypertension on the right or left is implicated in
the negative effects of increased afterload.
Affected by size of ventricle, wall tension, arterial
blood pressure
CO (HR X SV) blood ejected from the left
side of the heart in 1 minute (normal 4~8
min.)
HR ~controlled by ANS (unconscious)
SV~amount of blood ejected from the
ventricle with each beat, factors affecting
are PRELOAD, CONTRACTILITY &
AFTERLOAD.
Ejection Fraction – how well the left ventricle pumps blood out of the heart
Anemia – hemoglobin concentration is lower than normal
, sign of underlying disorder (not enough RBC’s or not enough hb in cells. Classified by what is
causing it – not making enough RBC’s hypoproliferative anemia, destruction of RBC’s (hemolytic), or
loss of RBC’s (bleeding)
Symptoms fatigue, dyspnea, dizziness, headache, feeling cold, weakness, breathlessness,
lightheadedness, palpitations, angina pectoris
Hypoproliferative
Iron-deficiency
Vitamin B12 deficiency
(megaloblastic)
Pernicious anemia
Folate deficiency
(megaloblastic)
Decreased erythropoietin
production (e.g. from
renal dysfunction)
Cancer / inflammation
Hemolytic
Altered erythropoiesis (sickle
cell, thalessemia, other
hemoglobinopathies)
Hypersplenism (hemolysis)
Blood loss
Bleeding from GI tract,
epistaxis, trauma, heavy
menses
Drug-induced anemia
Autoimmune anemia
Mechanical heart valve-related
anemia
Signs tachycardia or tachypnea if blood loss occurs rapidly
Chronic – pale skin, mucous membranes or nail beds, fissures at the corner of the mouth.
Aplastic
anemia
Pernicious
anemia
Anemia caused
by deficient red
cell production
due to bone
marrow disorders
Idiopathic cases
range from 40%
to 70%, most
common in
adolescents and
young adults;
exposure to
chemical and
antineoplastic
agents and
ionizing radiation
Chronic,
an autoimmune
macrocytic
disease; parietal
anemia marked
cells of the
by achlorhydria;
stomach lining
occurs most often fail to secrete
in 40- to 80-year- enough intrinsic
old northern
factor to ensure
Europeans of fair intestinal
skin, but has been absorption of
reported in other vitamin B12; due
races and ethnic
to atrophy of the
glandular mucosa
Bone marrow
transplantation or
immunosuppressive
drugs
Weakness, sore
tongue,
paresthesias
(tingling and
numbness) of
extremities, and
gastrointestinal
symptoms such as
diarrhea, nausea,
vomiting, and
pain; in severe
anemia, there
Vitamin B12 given
parenterally or, in
patients who
respond, orally
Folic acid
deficiency
groups; rare in
of the fundus of
may be signs of
blacks and Asians the stomach and
cardiac failure
is associated with
absence of HCl
acid
Anemia resulting Common in
from a deficiency patients who are
of folic acid; a
experiencing
cause of red cell
nutritional
enlargement
deficiencies (e.g.
(megaloblastic)
alcoholics,
patients with
malabsorption)
and during
hemolysis or
pregnancy.
Iron-deficiency Anemia resulting
anemia
from a greater
demand on stored
iron than can be
supplied. The red
blood cell count
may sometimes
be normal, but
there will be
insufficient
hemoglobin
Caused by
inadequate iron
intake,
malabsorption of
iron, blood loss,
pregnancy and
lactation,
intravascular
hemolysis, or a
combination of
factors
Foods rich in folic
acid – green leafy
vegetables,
asparagus, broccoli,
liver, organ meats,
milk, eggs, yeast,
wheat germ, kidney
beans, beef,
potatoes, dried peas
and beans, wholegrain cereals, nuts
bananas, cantaloupe,
lemons, and
strawberries
Chronically
Dietary intake of
anemic patients
iron is supplemented
often complain of with oral ferrous
fatigue and
sulfate or ferrous
dyspnea on
gluconate (with
exertion. Iron
vitamin C to
deficiency
increase iron
resulting from
absorption)
rapid bleeding
may produce
palpitations,
orthostatic
dizziness, or
syncope
Polycythemia – an excess of red blood cells; in a newborn it may reflect hemoconcentration due to
hypovolemia or prolonged intrauterine hypoxia, or hypervolemia due to intrauterine twin-to-twin
transfusion or placental transfusion resulting in delayed clamping of the umbilical cord (Taber’s)
Information for table from Taber’s
Polycythemia vera – a chronic, Symptoms – weakness,
Treatment – permanent cure
life-shortening
fatigue, blood clotting,
cannot be achieved today, but
myeloproliferative disorder,
vertigo, tinnitus, irritability,
remissions of many years can be
resulting from the reproduction flushing of the face, redness, produced. Phlebotomy,
of a single cell clone;
and pain or extremities occur radioactive phosphorus,
characterized by an increase in
red blood cell mass and
hemoglobin concentration that
occurs independently of
erythropoietin stimulation
commonly. Bone marrow
shows increased cellularity.
Peptic ulcers are often
reported.
cyclophosphamide,
hydroxyurea, or melphalan is
used. (also anagrelide (Agrylin)
Atherosclerosis – obstruction of blood flow w/I coronary arteries, characterized by CAD, plaque w/I
lumen of BV
Capillary refill – press nail, return to color w/i 3 seconds = adequate perfusion
Claudication – pain commonly in legs from too little blood flow usually from exercise
Compensation – walls of heart enlarge trying to compensate for failure on one side of the heart or the
other
Friction Rub – scratching or grating sound heard during both Systole and Diastole, between the
parietal and visceral pericardial layers, in the pericardial sac. (used in Dx for PERICARDITIS)
Heart failure – thickening of the ventricle layers,
Hemolytic Anemia – newborn, RH disease, red blood cells are destroyed faster than they are made
Hypoxia – deficiency in the amount of oxygen reaching body tissues
Intrinsic – substance produces & secreted by the parietal cells which enables the body to absorb B12,
ties into pernicious anemia aka ADDISON’s ANEMIA
Ischemia – heart muscle does not get enough oxygen and nutrients to meet demand, myocardial
ischemia, PATHO of CAD
Lymphedema – swelling of arms or legs, related to Cancer treatment pg 512
Hypertensive Crisis – BP higher than 180 and/or 120
Orthostatic Hypotension Diastolic Failure – major cause of morbidity and mortality, defined as symptoms of HF in a patient
with preserved left ventricular function – stiff and doesn’t relax which leads to increased end diastolic
pressure
Systolic Failure Pulmonary Edema
Paroxysmal nocturnal dyspnea
Systemic Vascular Resistance
Pernicious Anemia
Phlebitis
Polycythemia vera
Primary Hypertension
Secondary hypertension
Sodium restriction
Thrombophlebitis
Varicosities
Vasoconstriction
Venous insufficiency
Venous stasis
Vitamin B12
Identify the significant subjective and objective assessment data related to the cardiovascular system
that should be obtained from a client
Describe the age-related changes of the cardiovascular system and differences in assessment
findings
Explain the rationale and nursing implications for selected diagnostic studies
chest X-ray: Looking at cardiac silhouette for size and placement in chest, pericardial effusion and pulmonary
congestion.
Echocardiogram: ultrasound study with or w/o contrast. Evaluate valves, chamber size with contents,
ventricular and septal movement and thickness, pericardial sac for fluid and ascending aorta for
calcifications/aneurism. Can calculate E/F ejection fraction which gives a picture of left ventricular funct.
Normal is 53-73%. It is possible to have “preserved EF” with heart disease. Means ventricle can’t relax btwn
contractions.
MRI: 3D view. Newer model pacemakers OK.
Nuclear Studies: great way to see ventricular wall and septal mvmt. Also show coronary artery blood flow
during exercise. Can be activity or chemically simulate effects of exercise.
ECG: monitor electrical activity of heart. Deviations from normal – heart dysfunction.
TEE: pt swallows' probe. In esophagus, gives great visualization of heart. No eating until gag returns.
Cardiac cath: insertion femoral, radial , brachial/cephalic arteries. Injection of contrast. Post care: monitoring
of distal pulses to insertion.
Labs: Know normal, what information obtained from lab, any prep (ie fasting). Would also get electrolytes,
renal/liver studies, why?
BNP: elevated in heart failure. Measures hormone produced made by heart cells in ventricles from stretching.
Troponin: released by cardiac muscle that are undergoing degrading. 80% MI have elevation, can be seen 2-3
hour, but definitive r/o is 12 hours. This is why admit chest pain for obs.
Why clotting studies? PT, INR
TEE & TTE – echocardiography, posterior of the heart (L atrium), clots in the atrium (RF for stroke)
ECG – 10 electrodes
CXR – chest x-ray – size, shape and portion of the heart
Cardiac enlargement
Pulmonary congestion
Pneumonia
Pneumothorax
CHF
Increased preload causes increased stretching of the muscle measured by – BNP Brain Naturetic
Peptide >100 HF, blood test
blood pressure and the mechanisms involved in its regulation
Fig 33.1- p. 710
•can affect either CO or SVR, or both.
•Regulation of BP is a complex process involving both short-term (seconds to hours) and longterm (days to weeks) mechanisms.
•Short-term mechanisms, including the sympathetic nervous system (SNS) and vascular
endothelium, are active within a few seconds.
•Long-term mechanisms include renal and hormonal processes that regulate arteriolar
resistance and blood volume. In a healthy person, these regulatory mechanisms function in
response to the demands of the body. (Each mechanism is more fully described in the
following slides.)
Sympathetic nervous system
•The nervous system, within seconds after a drop in BP, increases BP primarily by activating the SNS.
•Increased SNS activity increases HR and cardiac contractility, produces widespread vasoconstriction in
the peripheral arterioles, and promotes the release of renin from the kidneys.
•The net effect of SNS activation is to increase BP by increasing both CO and SVR.
Baroreceptors
•Specialized nerve cells called baroreceptors (pressoreceptors)
• are located in the carotid arteries and the arch of the aorta.
•
•
important role in the maintenance of BP stability during normal activities.
sensitive to stretching and, when stimulated by an increase in BP, send inhibitory impulses to
the sympathetic vasomotor center.
• Inhibition of the SNS results in decreased HR, decreased force of contraction, and vasodilation
in peripheral arterioles.
•When a fall in BP is sensed by the baroreceptors, the SNS is activated. The result is constriction of the
peripheral arterioles, increased HR, and increased contractility of the heart.
•In the presence of long-standing hypertension, the baroreceptors become adjusted to elevated BP
levels and recognize this level as their new “normal.”
Vascular Endothelium
•The vascular endothelium is a single-cell layer that lines the blood vessels. It is essential to the
regulation and maintenance of vasodilating and vasoconstricting substances. Nitric oxide and
prostacyclin are both vasodilators. Endothelin (ET) is an extremely potent vasoconstrictor. A
disruption or dysfunction of arterial tone (either through excessive constriction or dilation) is an
early warning signal of CVD.
Renal System
•The kidneys contribute to BP regulation by controlling sodium excretion and extracellular fluid (ECF)
volume. Sodium retention results in water retention, which causes an increase in ECF volume. This
increases the venous return to the heart and stroke volume. Together, these increase CO and BP.
•The renin-angiotensin-aldosterone system (RAAS) also plays an important role in BP regulation. The
kidney secretes renin in response to SNS stimulation, decreased blood flow through the kidneys, or
decreased serum sodium concentration. Renin is an enzyme that converts angiotensinogen to
angiotensin I. Angiotensin I is then converted to angiotensin II by angiotensin-converting enzyme
(ACE). A-II increases BP.
•Prostaglandins (PGE2 and PGI2) secreted by the renal medulla have a vasodilator effect on the systemic
circulation. This results in decreased SVR and lowering of BP.
Endocrine System
•Stimulation of the SNS results in release of epinephrine along with a small fraction of NE by the adrenal
medulla. Epinephrine increases the CO by increasing the HR and myocardial contractility.
Epinephrine activates β2-adrenergic receptors in peripheral arterioles of skeletal muscle, causing
vasodilation. In peripheral arterioles with only α1-ardrenergic receptors (skin and kidneys),
epinephrine causes vasoconstriction.
•A-II stimulates the adrenal cortex to release aldosterone. Aldosterone stimulates the kidneys to retain
sodium and water. This increases blood volume and CO.
•An increased blood sodium and osmolarity level stimulates the release of ADH from the posterior
pituitary gland. ADH increases the ECF volume by promoting the reabsorption of water in the distal
and collecting tubules of the kidneys. The resulting increase in blood volume causes an increase in
CO and BP.
Discuss the pathophysiology, clinical manifestations, complications and nursing management
for the client experiencing hypertension
RF for Primary Hypertension
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Age
Alcohol
Smoking
Diabetes
Elevated serum lipids
Excess dietary sodium
Gender
Family history
Ethnicity
Sedentary lifestyle
Socioeconomic status
Stress
Obesity
BMI Categories:
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obese = BMI of 30 or higher
Weight Reduction
•Overweight persons have an increased incidence of hypertension and increased risk for CVD.
•Weight reduction has a significant effect on lowering BP in many people, and the effect is seen with
even moderate weight loss.
•A weight loss of 22 lb (10 kg) may decrease SBP by approximately 5 to 20 mm Hg.
•When a person decreases caloric intake, sodium and fat intake are usually also reduced. Although
reducing the fat content of the diet has not been shown to produce sustained benefits in BP control,
it may slow the progress of atherosclerosis and reduce overall CVD risk.
•Weight reduction through a combination of calorie restriction and moderate physical activity is
recommended for overweight patients with hypertension.
DASH Eating Plan
•The DASH eating plan emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole
grains, fish, poultry, beans, seeds, and nuts.
•Compared with the typical American diet, the plan contains less red meat, salt, sweets, added sugars,
and sugar-containing beverages.
•The DASH eating plan significantly lowers BP and these decreases compare with those achieved with
BP-lowering drug.
•Additional benefits also include lowering of low-density lipoprotein (LDL) cholesterol.
Dietary Sodium Reduction
•This involves avoiding foods known to be high in sodium (e.g., canned soups, frozen dinners) and not
adding salt in the preparation of foods or at meals.
•Average sodium intake is about 4200 mg/day.
•Patient and caregiver need to learn about sodium-restricted diets.
Moderation of Alcohol Intake
•Excessive alcohol intake is strongly associated with hypertension. Drinking three or more alcoholic
drinks daily is also a risk factor for CVD and stroke.
•Men should limit their intake of alcohol to no more than two drinks per day and women and lighterweight men to no more than one drink per day. One drink is defined as 12 oz of regular beer, 5 oz of
wine (12% alcohol), or 1.5 oz of 80-proof distilled spirits.
•Excessive alcohol intake that results in cirrhosis is the most frequent cause of secondary hypertension.
Physical Activity
•A physically active lifestyle is essential to promote and maintain good health.
•The AHA and American College of Sports Medicine recommend that adults perform moderate-intensity
aerobic physical activity for at least 30 minutes most days (i.e., more than 5) per week with a goal of
at least 150 minutes per week.
•Exercise goals can be accomplished by performing shorter periods of exercise that last at least 10
minutes or more.
•Additionally, combinations of moderate and vigorous activity are acceptable (e.g., walking briskly for 30
minutes on 2 days of the week and jogging for 20 minutes on 2 other days).
•For adults age 18 to 65, walking briskly at a pace that noticeably increases the pulse defines moderateintensity aerobic activity. Jogging at a pace that substantially increases the pulse and causes rapid
breathing is an example of vigorous activity for this age group.
•All adults should perform muscle-strengthening activities using the major muscles of the body at least
twice a week. This helps to maintain or increase muscle strength and endurance.
•Additionally, flexibility and balance exercises are recommended at least twice a week for older adults,
especially for those at risk for falls.
•Generally, physical activity is more likely to be done if it is safe and enjoyable, fits easily into one’s daily
schedule, and is inexpensive.
Avoidance of Tobacco Products
•Nicotine contained in tobacco causes vasoconstriction and increases BP, especially in people with
hypertension.
•Smoking tobacco is also a major risk factor for CVD.
•The cardiovascular benefits of stopping tobacco use are seen within 1 year in all age groups. Strongly
encourage everyone, especially patients with hypertension, to avoid tobacco use. Advise those who
continue to use tobacco products to monitor their BP during use.
Management of Psychosocial Risk Factors
•Psychosocial risk factors can contribute to the risk of developing CVD and to a poorer prognosis and
clinical course in patients with CVD.
•These risk factors include low socioeconomic status, social isolation and lack of support, stress at work
and in family life, and negative emotions such as depression and hostility. Frequently, these risk
factors are clustered together. For example, there tends to be higher rates of depression in
individuals who experience job stress.
•Psychosocial risk factors have direct effects on the cardiovascular system by activating the SNS and
stress hormones. This can cause a wide variety of pathophysiologic responses, including
hypertension
•Psychosocial risk factors can contribute to CVD indirectly as well, simply by their impact on lifestyle
behaviors and choices. Screening for psychosocial risk factors is important. Make appropriate
referrals (e.g., counseling), when indicated. Suggest behavioral interventions such as relaxation
training, stress management courses, support groups, and exercise training for individuals who are
not in acute psychologic distress.
The drugs currently available for treating hypertension have two main actions: (1) decrease the volume of circulating
blood and (2) reduce SVR.
The drugs used in the treatment of hypertension include:
 Diuretics promote sodium and water excretion, reduce plasma volume, and reduce the
vascular response to catecholamines.
 Adrenergic-inhibiting agents act by diminishing the SNS effects that increase BP. Adrenergic
inhibitors include drugs that act centrally on the vasomotor center and peripherally to
inhibit norepinephrine release or to block the adrenergic receptors on blood vessels.
 Direct vasodilators decrease the BP by relaxing vascular smooth muscle and reducing SVR.
 Calcium channel blockers increase sodium excretion and cause arteriolar vasodilation by
preventing the movement of extracellular calcium into cells.
 Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to
angiotensin II and reduce angiotensin II (A-II)–mediated vasoconstriction and sodium and
water retention.
 A-II receptor blockers (ARBs) prevent angiotensin II from binding to its receptors in the
walls of the blood vessels.
•Once antihypertensive therapy is started, patients should return for follow-up and adjustment of drugs
at monthly intervals until the goal BP is reached. More frequent visits are necessary for patients with
stage 2 hypertension or with co-morbidities. After BP is at goal and stable, follow-up visits can
usually be at 3- to 6-month intervals.
•Side effects of antihypertensive drugs are common and may be so severe or undesirable that the
patient does not adhere to the therapy. Patient and caregiver teaching related to drug therapy may
help the patient comply with therapy.
•Side effects may be an initial response to a drug and may decrease over time. Telling the patient about
side effects that may decrease with time may help the person to continue taking the drug. The
number or severity of side effects may relate to the dose. It may be necessary to change the drug or
decrease the dosage.
•A common side effect of several of the antihypertensive drugs is orthostatic hypotension. This
condition results from an alteration of the autonomic nervous system’s mechanisms for regulating
BP, which are needed for position changes. Consequently, the patient may feel dizzy and faint when
assuming an upright position after sitting or lying down.
•Sexual problems may occur with many of the antihypertensive drugs. This can be a major reason that
patients do not comply with the treatment plan. Problems can range from reduced libido to erectile
dysfunction. Rather than discussing a sexual problem with a HCP, the patient may decide just to stop
taking the drug.
•Diuretics cause dry mouth and frequent voiding. Sugarless gum or hard candy may help ease dry
mouth. Taking diuretics earlier in the day may limit frequent voiding during the night and preserve
sleep.
Advise the patient to report all side effects to the health care provider who prescribes the drug
ID risk factors for CAD and methods to alter select risks page 593
modifiable
Smoking
High total cholesterol, high LDL level, low HDL level, and high triglycerides
HTN
Diabetes
Obesity, particularly central obesity
Sedentary lifestyle/ physical inactivity
Stress
Excessive alcohol
Nonmodifiable - gender, race, men >45, genetics/family HX, postmenopausal
Clinical ,manifestations – ANGINA
Stable Angina – chest pain or discomfort ass with physical activity
Unstable Angina – chest pain at rest, precursor to MI, TX as emergency
ID dietary management for the client with CAD
American Heart Association (AHA) plan, DASH diet, Mediterranean diet, Ornish diet, and
the US Dietary Guidelines for Americans.
The heart-healthy benefits of the Medi-terranean diet continue to be the most widely examined.
Encourage
• Fresh, frozen, or canned fruits and vegetables (unsalted)
• Olive, canola, or peanut oil when cooking
• Raw or unsalted nuts and seeds, unsweetened nut butters
• Fish, poultry, and small amounts of lean, red meat that are grilled, baked, or boiled (avoid fried)
• Legumes and beans, such as great northern, pinto, black, garbanzo, and kidney beans
• Low-fat dairy products, such as milk, cheese, yogurt, and cottage cheese
• Whole grains in moderation, such as oatmeal, dried beans, barley, and brown rice
Describe a plan of care for the client experiencing chronic cardiovascular dysfunction
Compare and contrast the etiology, clinical manifestations, and management of selected
chronic venous and arterial alterations
Explain the nurse’s role in optimizing oxygenation in a client experiencing chronic
cardiovascular disease Keep O2 greater than 93%, cardiac dysrhythmias, especially TACHYCARDIA & ANXIETY
Discuss the psychosocial impact of chronic cardiovascular dysfunction on the client.
Depression and anxiety in 20% of the cases
I.
Cardiovascular System
Chapter 28 pp. 539-559
A. Structure and Functions of the Cardiovascular System (previously covered)
B. Assessment of Cardiovascular System (previously covered)
C. Diagnostic Studies of Cardiovascular System
1. Radiologic
a. Chest X-ray
b. Echocardiogram
c. MRI
d. Nuclear studies
2. Blood
a. Serum lipid profile
b. Cardiac Enzymes (Troponin I, CK-MB, myoglobin)
c. Clotting studies
e. CBC
3. Noninvasive monitoring
a. Electrocardiogram (ECG)
b. Holter monitor
c. Stress testing
d. Echocardiograms
e. Angiography (Cardiac catheterization, etc.)
II.
Hypertension
Chapter 31 pp. 620-629
III.
Coronary artery disease
Chapter 30 pp. 592-600
IV
Chronic constrictive pericarditis
VI.
Congestive heart failure
VII.
Anemias
A.
Chapter 30 pp. 604-607 Additional resource article
Chapter 30 pp. 611-618
Secondary to blood loss
Chapter 34 pp. 614-615
B.
C.
Hemolytic
D.
Nutritional
1. Iron deficiency
additional resources
Chapter 34 pp. 711-714
2. Vitamin B12 deficiency
Chapter 34 pp. 714-718
3.
Folic acid deficiency
Chapter 34 pp. 718-721
E.
Aplastic anemia
F.
Polycythemia vera
VIII.
Chapter 34 pp. 726-729
Chapter 34 pp. 729-732
Vascular disease
A.
Arterial disorders
1.
Peripheral vascular disease/ Peripheral Arterial Disease
2.
carotid artery Disease
Chapter 31 pp. 620-640 and
additional resource
articles
B.
Venous disorders/Peripheral Venous Disease
Chapter 31 pp. 635-640
articles
Veins
1.
Thrombophlebitis
2.
Venous insufficiency
3.
Varicosities/Varicose
Chapter 31 pp. 645-651
and additional resource
LEARNING OPPORTUNITIES
1. Design a teaching plan for the client experiencing hypertension.
2. Design a discharge teaching plan for a patient with congestive heart failure.
3. Identify community services available to the client with coronary artery disease.