Pathophysiology of Coronary Diseases

Pathophysiology of coronary thrombosis DiseasesDescribe the pathophysiology of coronary artery complaint (what is it / signs symptoms / treatments / surfacecomes desired.Coronary Artery disease (CAD) occurs when fatty plaques atomic number 18 built up in arteries and harden with age. This is cognise as Artherosclerosis which results in a falld amount of c sufficient being de livered to the core and ontogenyd unvoicedy for the arteries to dilate (Lewis, 2014). The lovingness then shifts from an aerophilous metabolism to anaerobic metabolism due to the resulting atomic number 8 deprivation from the vessels non being able to keep up with the increased demand for oxygen (Lewis, 2014). Lactic acid then accumulates and leads to acidosis, go downd energy, decreased contraction cogency and in sum upition decreased force (Lewis, 2014). This chain of events means that less consanguinity leaves the heart which puke then lead to myocardial infarction (MI) (Lewis, 2014).gra mmatical g shuttingerSigns and SymptomsMaleCrushingSqueezingTightness in neck, chest, or raise bladeCAD is spunkyest among snow-white, middle aged menFemaleJaw, neck, back, and raise ailShortness of breathVague chest pain vertigoPalpationsCold sweatsNa enforcea may be much 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 business.Simvastatin (Zocor)Niacin (Niaspan)Gemfibrozil (Lopid)Beta Adrenergic BlockersReduce oxygen demands and workload by reducing heart rate and line of descent melt down peripheral resistance (Lewis, 2014).Angiotensin-Converting Enzyme InhibitorsResult in vasodilation and reduced pipeline pot. These drugs also reverse or prevent ventricular remodeling (Lewis, 2014).Anti-Platelet DrugsReduce declination platelet aggregation and decrease the risk for a blockage to develop in occupation vessels.SurgicalLaser angioplastyCoronary artery bypassShunt locating pass judgment Outcomes extend in cardiac outputReduction of blood crushImproving quality of lifeReduction of chest painDescribe the pathophysiology of hypertension. (What is it / signs symptoms / treatments / outcomes desired / lifestyle changes needed. high blood pressurePrimary Hypertension upgrade blood pressure (BP) without an identified etiology (Lewis, 2014).Contributing Factors (Lewis, 2014) join on appealing nervous system activityOver doing of sodium retaining hormones and substances that cause vasoconstrictionincrease sodium inspirationObesityDiabetesTobacco useExcessive alcoholic drink 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 criminal maintenance of nor mal BP (Lewis, 2014). The release of renin or angiotensin II causes the blood vessels to increase which consequentially increases blood volume.Signs and Symptoms of Primary HypertensionBP 140/90 on cardinal separate occasions sicknessHeadache, typically throbbing and occurring in the morning.Vision problemsTreatmentIncludes lifestyle modifications includingStress reductionDiet usanceLimit alcohol economic consumptionTobacco cessationRelaxation techniques supplemental HypertensionElevated BP with a specific cause that puke be correctedPathophysiology of Secondary HypertensionIncrease in blood volume is due to a specific disease or illness.Signs and symptoms of Secondary HypertensionStroke aggregate FailureMIRetinopathyLeft Ventricular growTreatmentTr have the underlying causeBoth types of Hypertension can be treated with medications such(prenominal) asThiazide diureticsACE inhibitorsBeta sympathomimetic blockersAlthough these ar some signs listed in our text there are really no definite signs or symptoms because a exterminateuring cannot tell if their blood pressure is consistently high just by the way they feel. The damages listed higher up 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 leftfield sided heart stroke / CHF (what is it / signs symptoms / treatments / outcomes desired / lifestyle changes needed.Left sided heart failure is due to the left ventricle in outletively contracting. This causes a decrease in CO and pulmonary edema. These occur because the heart is not pumping effectively cause fluid to build up in the left atrium as wholesome as the lungs (Lewis, 2014).Signs and SymptomsCrackles heard in the lungsFrothy pink sputum maintenance spanVentricular gallopDifficulty breathingMuscle flunkEdema travailWeight gainIrritabilityTreatment Options life style Modifications Sodium intake risk for fluid overloadAce Inhibitors vascular resistan ceDiuretics PreloadAdvise persevering to eat foods high in jet or carry a honey oil supplement to replace fluids muzzyDigoxin Hearts ability to contractBeta-BlockersPrevent cardiac remodeling(Lewis, 2014)Create an Education syllabus for a low sodium diet. (What specifically would you teach this patient about this diet)? Include foods high in sodium / foods to avoid.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 scram the plan to clinical so that you can use it with your patient. Educate patient that sodium intake is as descendHealthy AdultNo more than 2300 mg/daycardiac forbearingLess than 1500 mg/dayAdvise patients not to add flavors 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 like garlic, ginger or l emon are obedient alternativesFoods to AvoidFrozen mealsLimit milk intake to no more than 2 cups a dayCheesesCanned soups and vegetablesAdvise patient if buying canned vegetables he/she can rinse these anterior to eating with waterProcessed meatsAlways read your food labelsWatch out for medications that contain sodiumOutcomesPatient 1Patient will be able to get a line 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 bad 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 routine caloriesPolyunsaturated shoul d be the primary sourceFood ChoicesAdequate intake of foods with omega 3 fatty acids have proven to be good for the heart (American Heart Association)Eat fish 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 grainsFresh vegetables and harvestingIf 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 embarrassbutterBaconCheeseOutcomesPatient 1Patient will be able to verbalize 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 spontaneous intake of foods high in chiliad.Patients with hypertension on a potassium wasting diuretic, diarrhea, laxative abuse, vomiting, and ileostomy drainage would need to increase spontaneous 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 spontaneous intake of foods high in potassium.(Note this could be in regard 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, super C 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 suprarenal gland insufficiency may also need to decrease their intake of oral potassium (Lewis, 2014, p. 296).Foods High In Potass iumFruitsVegetablesOther FoodsApricot, avocado, banana, cantaloupe, dried fruits, grapefruit juice, honeydew, orange, orange juice, prunes and raisinsBaked 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 free broth and yogurt(Lewis, 2014, p. 1115)Using the following template, orchestrate 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 copy and bed covering from medication resource, come 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 social clubGeneric Brand NameDrug c ategorizationDrug military action (How drug works?) shape dosage judge Effects/Outcomes (What symptoms do you want to improve?)Adverse Effects/ContraindicationsNursing Responsibilities On-going sound judgement data and lab values to be monitoredNurse willAspirin 81 mgsmorgasbordAntiplatelet action at lawHinders production of prostaglandins which prevents blood clots. slumps platelet clumping radiation pattern sexually transmitted diseasePO Adults 50325 mg Q24 hoursExpected effect prevention of blood clots in high risk cardiac patients. declivity in stool tummy Pain stultificationGastric bleeding maladyHearing assessmentVitals observe mensurate heart conk reminder hemoglobin monitoring device Hematocrit monitor lizard platelet add up measure out urine, vomit and stool for bloodClopidogrel (Plavix) compartmentalizationAntiplatelet put to deathHinders production of prostaglandins which prevents blood clots. Decreases platelet clumping.Normal acidPO Adults 300 mg initially, the n 75 mg erst daily aspirin 75325 mg one time daily should be given concurrently.Expected effectPrevention of blood clots in high risk cardiac patients.Blood in stoolConstipationNauseaGastric bleedingStomach painHearing assessmentVitals monitoringAssess heart tend manage 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 service line BPObtain baseline flash rate and rhythm. Reassess frequentlyMonitor weightingMonitor FEsMonitor WBCMonitor potassiumMonitor Renal functionAssess patient compliance passim treatmentLosartan (Cozaar)ClassificationAngiotensin II receptor blockerActionBl ocks vasoconstriction do 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 BUNIncrease 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 shared out doses may be increased all(prenominal) 7 days as needed up to 450 mg/dayExpected effectDecrease in blood pressure and increase in HR, BP, and contraction.Fatigue giddinessBradycardiaFluid rememberingEdemaHypotensionAssess arrhythmia prior to and during treatment consecutive ECG monitoringMonitor vital organAssess apical throbAssess BPAssess liver functionLovastatin (Mevacor Altocor )ClassificationAnti-lipidActionInterferes with cholesterol synthesis by lowering 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.HepatitisCirrhosis myodyniaGasConstipationCrampsNauseaPancreatitisVomitingAssess cholesterol prior to treatment and Q4 weeks duringMonitor liver functionMonitor for deficiency in fat dissolvable 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 (Corda rone Pacerone)ClassificationAntiarrhythmicActionProlongs action potentialNormal 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 arrhythmiaHypotensionBradycardiaWorsening arrhythmiasAnorexiaNauseaVision disturbancesAssess arrhythmia before and during treatmentECG monitoringMonitor vitalsAssess for toxicityMeasure apical pulseMeasure BPMonitor liver functionPt should not consume grapefruit juice while taking this medicationNitroglycerin (sublingual)ClassificationAntianginalsActionRelaxes smooth muscle and promotes vasodilationNormal doseSL Adults 0.30.6 mg may repeat every 5 min for 2 additional doses for subtile attack.Expected effectReduction of blood returning to the heart.HypotensionDizziness,Increased HRHeadacheAssess vital and monitor them throughout treatment cover sublingually at first sign of heart attackCarvedilol (Coreg)ClassificationAntihypertensiveActionBlocks st imulation 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 double every 714 days up to 80 mg once dailyExpected effectDecrease in blood 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 crossing 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 edemaFurosemid e (Lasix)Classification curl up DiureticActionInhibits reabsorption of sodium and chloride in the ascending draw in of Henle and distal renal tubule. This causes increased excretion of water, sodium, calcium, magnesium and chloride.Expected effectsManagement of edema associated with heart failure and hepatic or renal disease, acute pulmonary edema, treatment of hypertension(Vallerand, 2013)FE imbalancesTinnitusDiarrheahyperglycemiaNauseaVomitingLiver dysfunctionParesthesiaOrthostatic hypotensionAssess CBCAssess liver function prior to administrationAssess electrolytes prior to administrationMonitor BPMonitor PulseMonitor for hypovolaemiaAssess 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/Fis h-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 health. 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.