Chapter 40 Cardiovascular and Respiratory System Disorders Mosby

CARDIOVASCULAR DISORDERS Problems occur in the heart or blood vessels. With hypertension, the resting blood pressure is too high. Ø Ø • • The systolic pressure is 140 mm Hg or higher or the diastolic pressure is 90 mm Hg or higher. Causes include: Narrowed blood vessels Kidney disorders Head injuries Some pregnancy problems Adrenal gland tumors Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

• Hypertension can lead to: • Life-style changes can lower blood pressure. • Stroke Hardening of the arteries Heart attack Heart failure Kidney failure Blindness A diet low in fat and salt A healthy weight Regular exercise Not smoking Limiting alcohol and caffeine Managing stress and sleeping well Certain drugs can lower blood pressure. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 3

Ø Coronary artery disease (CAD, coronary heart disease, heart disease) • The coronary arteries are in the heart. • In CAD, one or all of the coronary arteries become • • hardened and narrow. The most common cause is atherosclerosis. The major complications of CAD are: • Angina Myocardial infarction (heart attack) Irregular heartbeats Sudden death The more risk factors, the greater the chance of CAD and its complications. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

• These risk factors cannot be controlled: • Gender (Men are at greater risk than women. ) Age (Risk increases with age. ) Family history Race (African-Americans are at greater risk than other groups. ) These factors can be controlled: Being overweight Lack of exercise High blood cholesterol Hypertension Smoking Diabetes Stress Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

• The goals of treatment are to: • Persons with CAD need to: • Relieve symptoms Slow or stop atherosclerosis Lower the risk of blood clots forming Widen or bypass clogged arteries Reduce cardiac events Quit smoking, exercise, and reduce stress Eat a healthy diet If overweight, lose weight Some persons need drugs to: Decrease the heart’s workload and relieve symptoms Prevent a heart attack or sudden death Delay the need for medical and surgical procedures Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 6

• Persons with complications from CAD may need cardiac rehabilitation. Cardiac rehab has two parts: – Exercise training – Education, counseling, and training Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Ø Angina (pain) is chest pain. • It is from reduced blood flow to part of the heart muscle • • (myocardium). Chest pain is described as tightness, pressure, squeezing, or burning in the chest. Symptoms can be relieved. • • • Rest often relieves symptoms in 3 to 15 minutes. A nitroglycerin tablet is taken when angina occurs. Some persons have nitroglycerin patches. Things that cause angina are avoided. Exercise programs are supervised by the doctor. Chest pain lasting longer than a few minutes and not relieved by rest and nitroglycerin may signal heart attack. The person needs emergency care. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 8

Ø Myocardial infarction (MI) • With MI, part of the heart muscle dies. • Sudden cardiac death (sudden cardiac arrest) can occur. MI also is called: Heart attack Acute myocardial infarction (AMI) Acute coronary syndrome (ACS) Coronary thrombosis Coronary occlusion Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 9

• • • CAD, angina, and previous MI are risk factors. MI is an emergency. Efforts are made to: • Relieve pain Restore blood flow to the heart Stabilize vital signs Give oxygen Calm the person Prevent life-threatening problems If the person survives: He or she may need medical or surgical procedures to open or bypass the diseased artery. Cardiac rehabilitation is needed. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 10

Ø Heart failure (congestive heart failure [CHF]) • Heart failure occurs when the heart is weakened and • • cannot pump normally. When the left side of the heart cannot pump blood normally, blood backs up into the lungs. When the right side of the heart cannot pump blood normally, blood backs up into the venous system. A very severe form of heart failure is pulmonary edema (fluid in the lungs). Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 11

• Common causes of heart failure are: CAD MI Hypertension Age Diabetes Irregular heart rhythms Damaged heart valves Kidney disease Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 12

• Treatment involves: Drugs are ordered to strengthen the heart. Drugs are ordered to reduce the amount of fluid in the body. A sodium-controlled diet is ordered. Oxygen is given. Semi-Fowler’s position is preferred for breathing. The person must reduce the risk factors for CAD. If acutely ill, the person needs hospital care. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 13

RESPIRATORY DISORDERS Ø Ø The respiratory system brings oxygen (O 2) into the lungs and removes carbon dioxide (CO 2) from the body. Respiratory disorders interfere with this function and threaten life. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 14

Ø Chronic obstructive pulmonary disease (COPD) • Chronic bronchitis, emphysema, and asthma are • grouped under COPD. Risk factors for COPD include: • • • Cigarette smoking Pipe, cigar, and other smoking tobaccos Exposure to second-hand smoke Not smoking is the best way to prevent COPD has no cure. COPD affects the airways and alveoli. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 15

Ø 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. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 16

Ø In emphysema, the alveoli enlarge and become less elastic. • Some air is trapped in the alveoli when exhaling. • • • O 2 and CO 2 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 drug therapy are ordered. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 17

Ø With asthma, the airway becomes inflamed and narrow. • Extra mucus is produced. • Signs and symptoms include: • • • 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 drugs. Severe attacks may require emergency care. Repeated attacks can damage the respiratory system. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 18

Ø Influenza (flu) • Influenza is a respiratory infection. • Caused by viruses, flu season is usually from • • • November through March. Most deaths from flu occur in older persons. Treatment involves fluids, rest, and relief of symptoms. Coughing and sneezing spread flu viruses. • Standard Precautions are followed. The flu vaccine is the best way to prevent the disease. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 19

• The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for persons who: Are 50 years of age and older Have chronic heart, lung, or kidney diseases Have diabetes Have immune system problems Have a severe form of anemia Will be more than 3 months pregnant during the flu season Are nursing center or assisted-living residents Are in close contact with children 0 to 23 months of age Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 20

Ø Pneumonia • Pneumonia is an inflammation and infection of lung tissue. • • Bacteria, viruses, and other microbes are causes. Microbes reach the lungs in these ways: • • Affected tissues fill with fluid. Being inhaled Aspirated Carried in the blood Children under 2 years of age and adults over 65 years of age are at risk. Older adults are at great risk of dying from the disease. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 21

• Factors that increase the risk of pneumonia include: • Smoking Aging Stroke Bedrest Immobility Chronic diseases Tube feedings Treatment may include: Drugs for infection and pain Increased fluid intake to treat fever and to thin secretions Intravenous therapy and oxygen Semi-Fowler’s position to ease breathing Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 22

• • • Rest is important. Standard Precautions are followed. Isolation Precautions are used depending on the cause. Mouth care is important. Frequent linen changes are needed because of fever. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 23

Ø Tuberculosis (TB) is a bacterial infection in the lungs. • It also can occur in other parts of the body. • If TB is not treated, the person can die. • TB is spread by airborne droplets with coughing, • • sneezing, speaking, singing, or laughing. Those who have close, frequent contact with an infected person are at risk. Risk factors include: Living in close, crowded areas Age Poor nutrition HIV infection Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 24

• TB can be present in the body but not cause signs and symptoms. • • Chest x-rays and TB testing can detect the disease. Treatment involves giving drugs for TB. Standard Precautions and Isolation Precautions are needed. The person must cover the mouth and nose with tissues when sneezing, coughing, or producing sputum. • Only persons with an active infection can spread the disease to others. Tissues are flushed down the toilet, placed in a biohazard bag, or placed in a paper bag and burned. Hand washing after contact with sputum is essential. Mosby items and derived items © 2008 by Mosby, Inc. , an affiliate of Elsevier Inc. 25