Pathophysiology of Coronary Diseases

Pathophysiology of Coronary DiseasesDescribe the pathophysiology of coronary artery disease (what is it / signs symptoms / tr decimatements / outcomes desired.Coronary Artery disease (CAD) occurs when fatty plaques argon built up in arteries and harden with age. This is known as Artherosclerosis which results in a decreased amount of smear being delivered to the optic and increased difficulty for the arteries to dilate (Lewis, 2014). The sum then shifts from an aerobic metabolism to anaerobic metabolism due to the resulting atomic number 8 deprivation from the vessels not being able to keep up with the increased demand for oxygen (Lewis, 2014). Lactic sulphurous then accumulates and leads to acidosis, decreased energy, decreased takeion strength and also decreased squelch (Lewis, 2014). This chain of events means that less relationship leaves the heart which slew then lead to myocardial infarction (MI) (Lewis, 2014).G rarityerSigns and SymptomsMaleCrushingSqueezing nearnes s in neck, thorax, or shoulder bladeCAD is broad(prenominal)est among white, middle aged menFemaleJaw, neck, back, and shoulder painShortness of breathVague chest painDizzinessPalpationsCold sweats nauseaMay be to a greater extent difficult to identifyTreatment OptionsSome examples of medicationsNitratesReduce the amount of oxygen that the heart uses.Lipid Lowering DrugsInhibit the synthesis of cholesterol in the liver which unexplainably increases hepatic LDL receptors. The liver is then able to remove more LDLs from the blood.Simvastatin (Zocor)Niacin (Niaspan)Gemfibrozil (Lopid)Beta Adrenergic BlockersReduce oxygen demands and workload by reducing heart rate and blood flow peripheral device resistance (Lewis, 2014).Angiotensin-Converting Enzyme InhibitorsResult in vasodilation and reduced blood volume. These drugs also reverse or prevent ventricular remodeling (Lewis, 2014).Anti-Platelet DrugsReduce platelet accumulation and decrease the attempt for a blockage to develop in b lood vessels.SurgicalLaser angioplastyCoronary artery bypassShunt placement anticipate OutcomesIncrease in cardiac widening decline of blood stormImproving quality of lifeReduction of chest painDescribe the pathophysiology of hypertension. (What is it / signs symptoms / interventions / outcomes desired / lifestyle changes needed.hypertensionPrimary Hypertension reverend blood pressure (BP) without an identified etiology (Lewis, 2014).Contributing Factors (Lewis, 2014)Increase sympathetic nervous system activityOverproduction of sodium retaining hormones and substances that cause vasoconstrictionIncreased sodium intakeObesityDiabetesTobacco useExcessive alcohol consumptionPathophysiology of Primary HypertensionIncreased cardiac output (CO) or Systemic vascular resistance (SVR) increases. This happens due to abnormalities of any of the mechanisms involved in the maintenance of normal BP (Lewis, 2014). The release of renin or angiotensin II causes the blood vessels to increase whic h consequentially increases blood volume.Signs and Symptoms of Primary HypertensionBP 140/90 on two separate occasionsNauseaHeadache, typically throbbing and occurring in the morning. stack problemsTreatmentIncludes lifestyle modifications includingStress reductionDietExerciseLimit alcohol intakeTobacco cessationRelaxation techniquesSecondary HypertensionElevated BP with a precise cause that can be correctedPathophysiology of Secondary HypertensionIncrease in blood volume is due to a specific disease or illness.Signs and symptoms of Secondary HypertensionStrokeHeart FailureMIRetinopathyLeft Ventricular HypertrophyTreatmentTreating the underlying cause some(prenominal) types of Hypertension can be treated with medications such asThiazide diuretics wholeness inhibitorsBeta adrenergic blockersAlthough these are some signs listed in our text there are really no definite signs or symptoms because a patient cannot tell if their blood pressure is consistently high school just by the way they feel. The modify listed above happen because there are no signs a person can feel on their own to warn them of their hypertension (Lewis, 2014).Describe the pathophysiology of left sided heart failure / CHF (what is it / signs symptoms / treatments / outcomes desired / lifestyle changes needed.Left sided heart failure is due to the left ventricle ineffectively contracting. This causes a decrease in CO and pulmonary edema. These occur because the heart is not pumping effectively causing fluid to build up in the left atrium as well as the lungs (Lewis, 2014).Signs and SymptomsCrackles perceive in the lungsFrothy pink sputum Attention spanVentricular gallopDifficulty breathingMuscle weaknessEdemaFatigue cargo gainIrritabilityTreatment OptionsLifestyle Modifications Sodium intake risk for fluid overloadAce Inhibitors vascular resistanceDiuretics PreloadAdvise patient to eat viandss high in kB or consume a potassium supplement to replace fluids lostDigoxin Hearts ability to co ntractBeta-BlockersPrevent cardiac remodeling(Lewis, 2014)Create an Education plan for a low sodium diet. (What specifically would you teach this patient about this diet)? Include foods high in sodium / foods to avoid.enthral have a detailed plan that you can use to teach a patient. The plan should have at least 2 patient outcomes listed. You need to bring the plan to clinical so that you can use it with your patient. Educate patient that sodium intake is as follow red-blooded AdultNo more than 2300 mg/ twenty-four hoursCardiac PatientLess than 1500 mg/ daytimelightAdvise patients not to add salts or seasonings to foods because it can increase sodium intake. They can choose options such as non-sodium seasonings instead (For Example Mrs. Dash offers AMAZING no-salt seasonings)Also, advise patient that using herbs for seasoning manage garlic, ginger or lemon are good alternativesFoods to AvoidFrozen mealsLimit milk intake to no more than 2 cups a dayCheesesCanned soups and vegetable sAdvise patient if buying canned vegetables he/she can rinse these front to eating with waterProcessed meatsAlways read your food labelsWatch out for medications that contain sodiumOutcomesPatient 1Patient will be able to name 3 alternatives to seasoning with salt by end of shift, Tuesday 12pm.Patient 2Patient will be able to name 3 food choices low in sodium by end of shift, Tuesday 12pm.(Lewis, 2014)Create an education plan for low fat, heart healthy diet. (What specifically would you teach this patient about this diet?) Include information on problematical fats versus good fats.Please have a detailed plan that you can use to teach a patient. The plan should have at least 2 patient outcomes listed. You need to bring the plan to clinical so that you can use it with your patient. Daily Fat Consumption25-35% of effortless caloriesPolyunsaturated should be the special sourceFood ChoicesAdequate intake of foods with omega 3 fatty acids have proven to be good for the heart (American Heart Association)Eat search at least two times a week (American Heart Association) omega-3 fatty acids decrease risk of arrhythmias, which can lead to sudden death. omega-3 fatty acids also decrease triglyceride levels, slow growth rate of atherosclerotic plaque, and lower blood pressure (American Heart Association).Eat moreWhole grains flip vegetables and fruitIf you cannot afford fresh fruit try fruit canned in natural juices versus syrupsLow fat cheeses and dairyAvoid processed foods, and those high in saturated fatsFoods high in saturated fats includeButterBaconCheeseOutcomesPatient 1Patient will be able to give tongue to ways to decrease fat consumption on a daily basis by end of shift, Tuesday 12pm.Patient 2Patient will be able to verbalize the need for consumption of Omega 3 fatty acids by end of shift, Tuesday 12pm.Give examples of situations when you would need to increase oral intake of foods high in potassium.Patients with hypertension on a potassium wasting diuretic, diarrhea, laxative abuse, vomiting, and ileostomy drainage would need to increase oral intake of foods high in potassium or take a potassium supplement (Lewis, 2014, p. 297).Give examples of situations when you would need to decrease oral intake of foods high in potassium.(Note this could be in look to disease processes or medications)Prepare a list of foods high in potassium. Please bring the list to clinical that you could use to teach the patient.Patients taking ACE Inhibitors, Potassium Sparing Diuretics or NSAIDS may need to decrease their intake of oral potassium (Lewis, 2014, p. 296). Also, patients who have nephritic disease, burn victims, Addisons disease, Tumor Lysis Syndrome and those with adrenal gland insufficiency may also need to decrease their intake of oral potassium (Lewis, 2014, p. 296).Foods High In PotassiumFruitsVegetablesOther FoodsApricot, avocado, banana, cantaloupe, dried fruits, grapefruit juice, honeydew, orangish, orange juice, prunes and raisinsBak ed beans, butternut squash, refried beans, black beans, cooked broccoli, carrots, greens (except kale), canned mushrooms, white and sweet potatoes, cooked spinach, tomatoes or tomato products, and vegetable juicesBran or bran products, chocolate, granola, milk, nuts, seeds, peanut butter, salt substitutes, salt liberal broth and yogurt(Lewis, 2014, p. 1115)Using the following template, prepare the following medication which many of the patients on 7S take (Remember that these are cardiac patients when looking at the indications of the medication) Please do not written matter and paste from medication resource, complete in your own words. Be sure to include your reference (24) points)**Do not copy and paste from medication resource, complete in your own words. Be sure to include your reference.Drug OrderGeneric Brand NameDrug categorizationDrug Action (How drug works?) commonplace dosageExpected Effects/Outcomes (What symptoms do you want to improve?)Adverse Effects/Contraindicat ionsNursing Responsibilities On-going estimation data and lab values to be monitoredNurse willAspirin 81 mgClassificationAntiplateletActionHinders production of prostaglandins which prevents blood clots. Decreases platelet clumping rule dosePO Adults 50325 mg Q24 hoursExpected effectPrevention of blood clots in high risk cardiac patients.Blood in tell onStomach PainConstipation stomachic bleedingNauseaHearing assessmentVitals monitoring appraise heart mold monitor lizard haemoglobin supervise HematocritMonitor platelet countAssess urine, vomit and stool for bloodClopidogrel (Plavix)ClassificationAntiplateletActionHinders production of prostaglandins which prevents blood clots. Decreases platelet clumping. natural dosePO Adults 300 mg initially, then 75 mg once daily aspirin 75325 mg once daily should be given concurrently.Expected effectPrevention of blood clots in high risk cardiac patients.Blood in stoolConstipationNauseaGastric bleedingStomach painHearing assessmentVitals mon itoringAssess heart functionMonitor hemoglobinMonitor HematocritMonitor platelet countAssess urine, vomit and stool for bloodLisinopril (Zestril Prinivil)ClassificationACE inhibitorActionStops angiotensin I from converting to angiotensin II. This reduces arterial resistanceNormal dosePO Adults 10 mg once daily, can be increased up to 2040 mg/dayExpected effectDecrease in blood pressure.FatigueHeadacheDry coughAngioedemaIncrease in serum potassiumIncrease in bunIncrease in CreatinineObtain baseline BPObtain baseline pulse rate and rhythm. Reassess frequentlyMonitor weightMonitor tarbooshMonitor WBCMonitor potassiumMonitor Renal functionAssess patient compliance throughout treatmentLosartan (Cozaar)ClassificationAngiotensin II receptor blockerActionBlocks vasoconstriction effects of angiotensin II.Normal dose50 mg once daily initially. May be increase to 100mg per day in 1-2 dosesExpected effectDecrease in blood pressure. .VomitingNauseaIncrease in serum potassiumIncrease in BUNIncre ase in creatinine levelsMonitor BP prior to admin. And throughout treatmentMonitor weightMonitor FEsMonitor potassiumMonitor renal functionAssess patient complianceMedication should be taken with food.Metoprolol (Lopressor)ClassificationAntihypertensiveActionBlocks stimulation of beta 1 adrenergic receptors.Normal dose25100 mg/day as a single dose initially or 2 divided doses may be increased every 7 days as needed up to 450 mg/dayExpected effectDecrease in blood pressure and increase in HR, BP, and contraction.FatigueDizzinessBradycardiaFluid retentionEdemaHypotensionAssess arrhythmia prior to and during treatmentContinuous electrocardiogram monitoringMonitor vitalsAssess apical pulseAssess BPAssess liver functionLovastatin (Mevacor Altocor)ClassificationAnti-lipidActionInterferes with cholesterol synthesis by gravid lipid levelsNormal dose20 mg once daily with evening meal. May be increased at 4-wk intervals to a maximum of 80 mg/dayExpected effectDecrease in cholesterol.Hepatit isCirrhosisMyalgiaGasConstipationCrampsNauseaPancreatitisVomitingAssess cholesterol prior to treatment and Q4 weeks duringMonitor liver functionMonitor for want in fat soluble vitamins A, D, E and KMonitor for deficiency in folic acidAtorvastatin (Lipitor)ClassificationAnti-lipidActionInterferes with cholesterol synthesis by lowering lipid levelsNormal dose1020 mg once daily initially may be increased every 24 weeks up to 80 mg/dayExpected effectDecrease in cholesterol.HepatitisCirrhosisMyalgiaGasConstipationCrampsNauseaPancreatitisVomitingAssess cholesterol prior to treatment and Q4 weeks duringMonitor liver functionMonitor for deficiency in fat soluble vitamins A, D, E and KMonitor for deficiency in folic acidAmiodarone (Cordarone Pacerone)ClassificationAntiarrhythmicActionProlongs action authorityNormal dosePO Adults 8001600 mg/day in 12 doses for 13 weeks then 600800 mg/day in 12 doses for 1 month then 400 mg/day maintenance dose.Expected effectDecrease in arrhythmiaHypotensio nBradycardiaWorsening arrhythmiasAnorexiaNauseaVision disturbancesAssess arrhythmia before and during treatmentECG monitoringMonitor vitalsAssess for toxicity valuate apical pulseMeasure BPMonitor liver functionPt should not consume grapefruit juice while taking this medicationNitroglycerin (sublingual)ClassificationAntianginalsActionRelaxes swimming muscle and promotes vasodilationNormal doseSL Adults 0.30.6 mg may repeat every 5 min for 2 additional doses for acute attack.Expected effectReduction of blood returning to the heart.HypotensionDizziness,Increased HRHeadacheAssess vital and monitor them throughout treatmentAdminister sublingually at first sign of heart attackCarvedilol (Coreg)ClassificationAntihypertensiveActionBlocks stimulation of beta 1 adrenergic receptorsNormal doseHypertension 6.25 mg twice daily, may be q 714 days up to 25 mg twice daily or extended-release 20 mg once daily, dose may be doubled every 714 days up to 80 mg once dailyExpected effectDecrease in blo od pressure and increase in HR, BP, and contraction.FatigueBradycardiaDizzinessHypotensionFluid retentionEdemaAssess arrhythmia prior to and throughout treatmentContinuous ECG monitoringMonitor vitalsAssess apical pulseAssess BPAssess liver functionAmlodipine (Norvasc)ClassificationAntihypertensiveActionPrevents calcium from product myocardial cell membrane and vascular smooth muscleNormal dosePO Adults 510 mg once dailyExpected effectDecrease in blood pressureOrthostatic hypotensionHeadacheDizzinessEdemaArrhythmiasAssess vitalsMonitor ECG throughout treatmentMonitor vitalsMonitor liver functionPt will need assistance w/ ambulationMonitor FEsEducate patient on need to decrease sodium and fluids to subsequently decrease edemaFurosemide (Lasix)ClassificationLoop DiureticActionInhibits reabsorption of sodium and chloride in the rising slope loop of Henle and distal renal tubule. This causes increased excretion of water, sodium, calcium, magnesium and chloride.Expected effectsManageme nt of edema associated with heart failure and hepatic or renal disease, acute pulmonary edema, treatment of hypertension(Vallerand, 2013)FE imbalancesTinnitusDiarrheaHyperglycemiaNauseaVomitingLiver dysfunctionParesthesiaOrthostatic hypotensionAssess complete blood countAssess liver function prior to administrationAssess electrolytes prior to administrationMonitor BPMonitor PulseMonitor for hypovolemiaAssess for diuresisAssess for polydipsiaAssess mucous membranesAssess skin turgorMonitor for edemaMonitor weightIOsAll drugs referenced (Vallerand, 2013)ReferencesAmerican Heart Association Fish and Omega-3 Fatty Acids. (2014, May 14). Retrieved February 13, 2015, from http//www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jspLewis, S. M., Dirksen, S. R. (2014). Medical-surgical nursing assessment and management of clinical problems (Ninth ed.). St. Louis Elsevier.Louie, D., Wedell, R. (2014). Optimizing heart hea lth. American Nurse, 46(3), 13.Vallerand, A. H., Sanoski, C. A. (2013). Daviss drug guide for nurses (Fourteenth ed.). Phila-delphia F.A. Davis Company.