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

Nursing Considerations recovery 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 Venous stasis 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 Stroke Brain 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 Dysphasia Dysphagia Damage to the brain’s speech center Unable to speak Dysphasia Inability to say what one wishes to say Dysphagia Swallowing difficulty

Chances of recovery Deficits Brain Damage Chances of recovery Deficits

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 Organic changes 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