Coronary Artery Disease

Ischemic heart disease

Angina Pectoris

Development of plaques Vessels narrow or become

obstructed Ischemia

Prolonged deficiency of oxygenated blood

Angina “pain in chest”

Signs and Symptoms

Distribution of pain Sensation of tightening Faint Dyspneic Pale

Diagnostic Test

ECG (ekg) Cardiac enzymes Xray Medical history

Medical and Surgical treatment

Medications Diet and exercise Reduction of risk factors Invasive and intervention

procedures

Nursing considerations

Teaching Lifestyle changes Medications Compliance

Myocardial Infarction

Blockage of coronary arteries Damage to the myocardium and

conduction system Diminished blood flow Life threatening dysrhythmias Ineffective pump

Signs and Symptoms Pain Panic Restlessness Confusion Ashen Cold Clammy Dyspnea

Cyanosis Rapid thready

pulse Irregular pulse Drop in BP Drop in body temp Sense of

impending doom

Diagnostic test

ECG Cardiac enzymes Xray BMP Coagulation studies

Medical treatment

Pain relief Medications Oxygen Rest

Nursing Considerationsacute phase

Assessment Vital signs Cardiac monitoring I/O, daily weight Lab and xray Medications

Nursing Considerationsrecovery phase

Bowel movement Cardiac rehab-exercise Rest Diet Treatment and medications Risk factors Compliance

Blood Vessel Disorders

Inflammatory disorders and Complications

Thrombophlebitis

Inflammation Blood clot formation Deep vein thrombosis Phlebitis Coagulability

Thrombophlebitis

Predisposing factors Pressure Prolonged inactivity Prolonged immobilization

Venous stasis Decrease venous return

Signs and Symptoms

Pain Redness Swelling Fever Fatigue Positive Homans’ sign

Medical treatment

Imaging studies Medications Lab tests rest

Nursing Considerations

Exercise plan Bed rest Antiembolism stockings Medications

Embolism

Pulmonary embolism Coronary embolism Cerebral embolism Peripheral embolism

Surgical treatment

Ligation (tied off) Filter placed

Peripheral Vascular Disorders

Intermittent claudication Tingling and numbness Coldness and difference in size Lack of new tissue growth

Buerger’s disease Thromoangiitis obliterans

Inflammation causes obstruction of blood vessels

Cramps in calf muscle-exercise Tingling, burning and numbness Edema-pitting or brawny Mottled purple red hue- dependent Pale when elevated Ulcers-infection-gangrene Amputation

Medical and surgical treatment

Mild exercise- buerger-allen exercises

Medications Clothing Diet and fluid intake

Raynaud’s Phenomenon

Spasmodic constriction of arteries Blanched cold extremities Numb-prickly- perspire-blue Progresses-cyanosis-ulcers Skin shiny and tight Avoid cold Medications to relieve spasms

Varicose Veins Weakening valves of the veins Blood pools Predisposing factors

Heredity Weakening vein walls Poor posture Prolonged standing Tumors Hypertension obesity

Signs and symptoms

Dark, tortuous superficial veins Dark protrusions when standing Pain Fatigue Feeling of heaviness Muscle cramps

Medical and Surgical treatment

Elevating legs Avoiding constriction, standing long

periods and restrictive clothing Measures aimed at promoting venous

return Surgical ligation and stripping of

varicose veins Sclerosing-injection

Nursing considerations

Teaching Measures to promote venous

return Antiembolism stockings Elevate legs Ambulation

Telangiectasia (spider veins)

Small dilated blood vessels Treated by scleropathy

Aneurysms Outpouching of a blood vessel

Congenital Trauma Increased pressure of arteriolosclerosis

Vessel may hemorrhage or rupture Surgical intervention if in an operable

site Surgical repair-clamping, removal or

synthetic graft

Cerebrovasular Accident

StrokeBrain attack

Causes of cerebrovascular accident

Contributing factors Causes of CVA

Cerebral thrombosis Cerebral hemorrhage or aneurysm Cerebral embolism

Stages of CVA

Transient ischemic attack Reversible ischemic neurological

deficit Stroke in evolution Completed stroke

Signs and Symptoms Dizzy spells Memory loss Ringing in the ears

(tinnitus) Headache-nausea and

vomiting Loss of consciousness Face red Breathing noisy and

strained BP elevated

Pulse slow but full and bounding

Inconsistent behavior

Easily fatigued Loss of bowel and

bladder control Poor balance Deep coma

Results of CVA

Hemiplegia Paralysis of one side of body

Flaccid stage Numbness and weakness

Spastic stage Muscles contracted, tense and movement

difficult Recovery stage

Therapy and rehabilitation

Aphasia and Dysphasia

Aphasia Damage to the brain’s speech center Unable to speak

Dysphasia Inability to say what one wishes to

say Dysphagia

Swallowing difficulty

Brain Damage

Chances of recoveryDeficits

Hemianopsia

Blindness in half of the visual field of one or both eyes

Approach from the unaffected side Teach client to scan to see things

Pain

Very little pain associated with CVA

Secondary health issues Infection Kidney Bladder Fecal impaction

Autonomic Disturbances

Perspiration or “goose flesh” above paralysis

Dilated pupils High or low blood pressure headache

Personality changes

Functional Frustration unable to walk or talk Useless or helpless

Organic changes Blockage of blood supply to part of

brain

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