Chapter 35

Cardiovascular and Respiratory Disorders

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Cardiovascular Disorders

Cardiovascular and respiratory system disorders are leading causes of death in the United States.

With hypertension (high blood pressure), the resting blood pressure is too high. Narrowed blood vessels are a common cause. Signs and symptoms develop over time. Hypertension can lead to:

• Stroke• Hardening of the arteries• Heart attack• Heart failure• Kidney failure• Blindness

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Lowering Blood Pressure

These measures can lower blood pressure:

A diet low in fat and salt A healthy weight Regular exercise No smoking Limiting alcohol and caffeine Managing stress and sleeping well Certain medications

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Coronary Artery Disease

Coronary artery disease (CAD) In CAD, the coronary arteries become hardened and narrow.

The heart muscle gets less blood and O2. The most common cause is atherosclerosis. The major complications of CAD are:

• Angina• Myocardial infarction (heart attack)• Irregular heartbeats• Sudden death

These risk factors cannot be controlled:• Gender (Men are at greater risk than women.)• Age• Family history• Race (African-Americans are at greater risk than other groups.)

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CAD: Controllable Factors and Treatment Goals

These factors can be controlled:• Being over-weight• Lack of exercise• High blood cholesterol• Hypertension• Smoking• Diabetes

Treatment goals are to:• Relieve symptoms.• Slow or stop atherosclerosis.• Lower the risk of blood clots.• Widen or bypass clogged arteries.• Reduce cardiac events.

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Angina

Angina is chest pain.• It is from reduced blood flow to part of the heart muscle.

• Chest pain is described as a tightness, pressure, squeezing, or burning in the chest.

• Symptoms are relieved by rest and a nitroglycerin tablet. Some persons have nitroglycerin patches.

• Things that cause angina are avoided, such as over-exertion, heavy meals and over-eating, and emotional stress.

• Exercise programs are supervised by the doctor.

• Chest pain lasting longer than a few minutes and that is not relieved by rest and nitroglycerin may signal heart attack. The person needs emergency care.

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Myocardial Infarction

Myocardial infarction (MI)• In MI, blood flow to the heart muscle is suddenly blocked.• Part of the heart muscle dies.• MI is an emergency.• Sudden cardiac death (arrest) can occur.• MI is also called a heart attack, an acute myocardial

infarction (AMI), an acute coronary syndrome (ACS), a coronary, a coronary thrombosis, or a coronary occlusion.

• Efforts are made to: Relieve pain Restore blood flow to the heart Stabilize vital signs Give oxygen Calm the person Prevent death and life-threatening problems

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Myocardial Infarction (Cont’d)

CAD, angina, and previous MI are risk factors.

The person may need medical or surgical procedures to open or bypass the diseased artery.

The person needs cardiac rehabilitation. The goals are to:

Prevent another MI. Prevent complications such as heart failure or

sudden cardiac arrest. Recover and resume normal activities.

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Congestive Heart Failure

Heart failure or congestive heart failure (CHF) occurs when the heart is weakened and cannot pump normally.

Left-sided failure (Blood backs up into the lungs.) Right-sided failure (Blood backs up into the venous system.) Results of CHF include:

• Poor blood flow to the brain causes confusion, dizziness, and fainting.

• The kidneys produce less urine.• Skin is pale.• Blood pressure falls.

A very severe form of CHF is pulmonary edema, fluid in the lungs.

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CHF: Causes and Treatments

Common causes include:• Damaged or weak heart• CAD• MI• Hypertension• Age• Diabetes• Irregular heart rhythms • Damaged heart valves• Kidney disease

Treatment includes:• Drugs to strengthen the heart and reduce the amount of fluid in

the body• Sodium-controlled diet• Oxygen• Semi-Fowler’s position• Reduction of CAD risk factors

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Respiratory Disorders

The respiratory system brings oxygen (O2) into the lungs and removes carbon dioxide (CO2) from the body.

Respiratory disorders interfere with this function and threaten life.

Chronic obstructive pulmonary disease (COPD) Two disorders are grouped under COPD (chronic bronchitis,

and emphysema). COPD is a leading cause of death in the United States. Cigarette smoking is the most important risk factor. Not smoking is the best way to prevent COPD. COPD has no cure.

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Bronchitis

Chronic bronchitis occurs after repeated episodes of bronchitis. Bronchitis means inflammation of the bronchi. Smoking is the major cause. Infection, air pollution, and industrial dusts are risk factors. Smoker’s cough in the morning is often the first symptom. Treatment involves:

• The person must stop smoking.

• Oxygen therapy and breathing exercises are often ordered.

• Respiratory tract infections are prevented; if one occurs, the person needs prompt treatment.

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Emphysema

In emphysema, the alveoli enlarge and become less elastic. Some air is trapped in the alveoli when exhaling.

• O2 and CO2 exchange cannot occur in affected alveoli. Smoking is the most common cause. Air pollution and industrial dusts are risk factors. The person has shortness of breath and a cough. Breathing is easier when the person sits upright and slightly

forward. Treatments:

• The person must stop smoking.• Respiratory therapy, breathing exercises, oxygen, and

medications are ordered.

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Asthma

With asthma, the airway becomes inflamed and narrow. Extra mucus is produced. The symptoms are mild to severe.

• Dyspnea

• Wheezing and coughing

• Pain and tightening in the chest

Asthma usually is triggered by allergies. Sudden attacks (asthma attacks) can occur. Asthma is treated with medications. Severe attacks may require emergency care.

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Influenza (Flu)

Influenza (flu) is a respiratory infection caused by viruses. Most deaths from flu occur in older persons. Older persons may not have typical signs and symptoms.

• Changes in mental status• Worsening of other health problems• A body temperature below normal range• Fatigue• Decreased appetite and fluid intake

Treatment involves:• Fluids, rest, and relief of symptoms• Drugs for symptom relief and to shorten the flu episode

Flu viruses are spread through coughing and sneezing.• Standard Precautions must be followed.

The flu vaccine is the best way to prevent the disease.

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Pneumonia

Pneumonia is an inflammation and infection of lung tissue. Affected tissues fill with fluid. Bacteria, viruses, and other microbes are causes. The person is very ill. Children less than 2 years of age and adults greater than 65

years of age are at risk. Signs and symptoms include:

• High fever, chills, painful cough, chest pain on breathing, and rapid pulse

• Shortness of breath and rapid breathing• Cyanosis• Sputum is thick and white, green, yellow, or rust-colored.• Nausea, vomiting, headache, tiredness, and muscle aches

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Pneumonia (Cont’d)

Older adults are at great risk of dying from pneumonia. Risk factors include smoking, aging, stroke, bedrest,

immobility, chronic disease, and tube feedings. Pneumonia from aspiration is common in older persons. Older persons may not have the typical symptoms; they may

show signs of confusion, dehydration, and rapid respirations. Treatment for pneumonia includes:

• Medications are ordered for infection and pain.• Increased fluid intake to thin secretions and for fever• Intravenous therapy and oxygen as needed• Semi-Fowler’s position eases breathing.• Rest• Standard precautions• Isolation precautions, depending on the cause

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Tuberculosis

Tuberculosis (TB) is a bacterial infection in the lungs. TB is spread by airborne droplets with coughing, sneezing,

speaking, singing, or laughing. Risk factors include close, frequent contact with an infected

person; living in close, crowded areas; age; poor nutrition; and HIV infection.

Chest x-ray and TB testing can detect the disease. Medications for TB are given. The mouth and nose are covered with tissues when the

person sneezes, coughs, or produces sputum. Hand washing after contact with sputum is essential. Standard Precautions and Isolation Precautions are

followed.

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Quality of Life

Heart and lung function are essential for life. Fears of death are common.

The care you give affects the person’s quality of life.

Follow the care plan to meet the person’s basic needs. This includes the person’s emotional needs.

Protect the person’s rights. Follow Standard Precautions and the

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