health and illness test 3

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health and illness test 3
2012-03-29 14:40:11
health illness test

health and illness test 3
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  1. · Bacteria and viruses can affect the heart
    ·Cardiomyopathy- strain of heart muscle, in cure needs heart transplant
    ·Assess general appearance, get good health history, weight gain, heart palpation, numbness, skin color very important,
    cardiac disrthymias- EKG, itching, jaundice, cough
    · All systems will eventually be affected
    ·Testing- noninvasive: EKG, holter monitor, pulse oximetry, echocardiogram, transesophageal echocardiogram, chest xray, ct,mri
    ·Nuclear cardiology- thallium scan- detects CAD, and bundle branch clog, pet scan, stress test
    ·Cardiac catheter- check distal pulses, numbness or bleeding – apply pressure call dr., iv fluids after to flush dye,
    ·Angiography- iv dye injected, dx. CHF, npo for 4hours before, sedative, antihistamine, cardiac cap-
    ·Hemodynamic monitoring- blood volume, heart pressure and vascular system. Catheter surgically
    • · Methods: direct b/p monitor, CVP monitor, factors
    • decrease preloadamount of blood in left vent. At end of diastole, PWP(pulmonary wedge pressure): measure after load, after load decreases, blood studies, serum enzymes lsoenzymes
    • ·After load- vasodilation-decrease, HBP- increase, afterloaad affects rate of contraction, and heart rate,
    • ·Troponin- found in myocardial- t1, and T
    • ·Peaks 4-24 hours, stays elevated for up to 7 days,
    • ·Ck-mb, ldh1, ldh2: isoenzymes evaluating for heart attack
    • ·Creatinine kinase (CK)- found in brain and heart, skeletal) goes back to normal 72 hours after attack
    • ·Ldh1increases 8-12h after m.i. returns to normal 5-7 days, ldh2,3,4,5- heart, liver, lung and brain, 3- lungs, 4&5-skeletal muscle, normal 2 higher than1
  2. · Aspirate aminotransferace(AST)- blood test- myoglobin damaged blood cells released, back to normal in 18 hours
    ·Inflammatory conditions- rheumatic fever, rheumatic carditis after strep A, affects heart valves- mitral, antibodies counter react and destroys heart, scar tissue forms- affects heart vavles thicker, get leakage, fiberous tissue, “ashcock bodies” smokers,
    ·s/s- jones criteria: 5-15 age, 2-3 weeks after strep, CARDITIS, POLYARTHRITIS, SUBCUTANEOUS NODULES, CHOREA- cant use skeletal system organized, INCREASED HEART RATE, RASH- RED SPOTTY, JOINTS AFFECTED KNEES HIPS SHOULDERS, goes away in 6 months, hear a pericardial friction rub, heart murmur, can go into CHF, DX: not one test, throat culture, blood titter, ESR- sed rate, CRP- c-reactive protein, give antibiotics and control symptoms, asa to kids over 18 with signs of carditis,
    • ·carditis- look at which heart valve is affected, surgery- if needed to fix heart,
    • · acute endocarditis- by infection anywhere in body, strep or staph., valves usually damaged, night sweats, murmur, chills,
    • fever, enlarged spleen, “pitcia”, no treatment,

    • · sub acute- pt already has heart damage, loss of appetite, weak, fatigue, clot travels through blood stream goes to heart valve,
    • · Myocarditis- rare but linked to viruses, cause unknown, drug sensitivity, HIV, Chemo radiation- more at risk, end up in CHF,
    • · R side CHF- distended heart viens , left sided-
    • crackle in lungs friction rub, muscle aches, lymph nodes enlarged, biopsy-test, look
    • ·Pericarditis- on outside of heart, history of tb, tumors, connective tissue disorders, scleroderma, acute pericarditis- fluid accumulation pericardial sac- “cardiac tampina”- pressure on the heart
    • Look for chest pain, fever, dyspnea, heavy chest, pain radiates, grating or sharp pain- on inspiration, pain relieved by setting up lean forward, increased pulse, dx: ekg, sed rate- non specific test to pick up inflammation, elevated bun, creatitine, waste product in blood, antibiotic 4-6 weeks, bedrest, brp only for acute,
  3. ·Cardiomyopathy:
    o dilated-most common, decreased blood flow, blood
    clots, result of myocarditis, vaso constrictors?
    o Hypertrophied- left vent. Wall rigid- sudden death, young adults, after puberty, beta blockers, calcium channel blockers, surgery- “myoepithamie”, left vent enlarges,
    o Restrictive- left vent. Feeling is limited, pedi 5%, rare, don’t give vasodilators,
    ·CHF- dx- chest xray, echocardiogram, biopsy of endomyocardia,
    · Venous disorders- thrombophlebitis- keep active,
    prevention- dvt don’t use “homeinsign”, most will not use blood thinners for superficial thrombophlebitis- veracious veins, instert green or umbrella filter, embolism is big issue, 4-6 hours from onset- give clot buster, sudden chest pain, tell people not to cross legs,
    ·Atherosclerosis- prevention is best, plaque hardening in the lining of artery/ arteries get clogged
    ·“Occlusive” disorder can lead to PAD,
    ·Arthrosclerosis lumen of artery opening fills with fatty deposit “athroroma”- name of fat
    ·Hyperlipidima- increase level of blood fat, Take “statine” at bed time to lower cholesterol (Lipitor)
    • ·Coronary artery disease(CAD)- tired all the time, chest pain,
    • ·MI- heart tissue dies- “left ventricle blown”, pain rushing, sub sternum pain, shoulder jaw pain, indigestion; procedures balloon angioplasty, cardiac catheter(I wrote remove itbut not sure why), cardiac stent, cabbage- open heart surgery, on bypass machine because of blood less
    • surgery,

    • ·
    • PVD,CAD- pain center of chest, vasodilator- nitroglycerin, if left untreated pt will get MI- die from it
    • · Angina-
    • o Unstable: unpredictable, worsening CAD, rest does not relieve pain
    • o “princemount” angina- normal activity or resting, pain same time each day, does not affect heart as much
    • o Stable angina- blood flow not to artery, pain for about a month, rest helps , can give up to 3 doses of nitroglycerin in 5 minutes
    • o Diagnosis: nitroglycerin relieves pain, stress test, depressed ”st” segment (increase”ST”= MI), angiogram,
    • · Nitrol- long acting, takes off at night, used PRN
    • ·Beta blockers- slow down everything, hold when B/P below 100, pulse below 60, “enderal”- not for asthma or DM pt.
    • · Can give daily asa
    • · Calcium channel blockers- relaxes smooth muscle, ex: procardium – treat angina(the 2nd one), teach side effects,
    • diet- low sodium, low chol., small freq. meals, low cal.
    • ·nitro.- rebound effects- HA, pt. should carry meds at all times, replaced if opened for more than 6 months, 3 doses in 5 min.
    • · if pt has heart attack stay with them
  4. ·MI- heart attack, dead tissue,
    o Anterior MI- Left coronary artery feeds left
    vent. And ant. Wall
    o Inferior MI- right coronary, SA and AV nodes-
    very serious
    Lateral wall MI- left vent., post. Wall(part of
    it), usually clot, takes 7 hours for heart attack to be done, 48 hour critical time, ischemia- happens in 35-45 min. for tissue to die
    Silent MI- no S/S, mainly women,
    o S/S- “thrushing?”, chrushing chest pain, not
    relieved by nitro, nausea, indigestion, crackles in lungs, and wheezing, extra heart sound( going into heart failure), inverted T wave, look at troponine levels- 1 andT, myoglobin, CKMB- enzymes myocardial damage, wbc- increase after MI- 1200+in few hours for 5-7 days, serum cardiac enzymes released only when damage from heart attack,
    o Tx: 15 min. of unrelieved pain, analgesic
    usually IV, nitrace, anticoagulation, enzyme inhibitors, cardiac lidocaine- for PVCs, anxiety- valum, stool softeners, iv fluids with an open line, Demerol drops blood pressure and respirations,
    ·Rest the heart , bed rest or bedrest with BRP,-1-3 days,
    ·Catheter into heart-“ swandance” catheter, measures pressure in the heart, polumnary pressure, O2 2-5 liter per min.
    ·Heart rate drops below 40, complete heart block-put in pace maker, possible clot buster meds. 4-6 hours tissue dies, give heparin drip, then Coumadin
    ·Cardiac cath- to find blockage, angioplasty during cath., intra aortic balloon pump helps heart to not pump as hard
    ·Pt needs to know S/S- chest pain, sweating,, etc., start exercise program- start with one to two steps for exercise, diet, cardiac rehab
    • ·Aneurism- leak on area of the wall of blood vessel, unknown causes- atherosclerosis, smoking, abdominal aortic aneurism,
    • ·Aneurism: types: “abusive form”, secular- bulg on one side, dissecting caity air inside wall,
    • ·S/S: back flank pain, shock, high death rate, ct scan, abd. Or aorticgram, meds b/p, surgery by pass, AF bypass-5-7 mm or larger, increased blood pressure can blow graft, teaching
    • ·“rhinonoids disease, bergers, various vein,
    • ·CHF- stops pumping, heart rate below 43, most common is CAD, fluid leads to edema, pulmonary back up right side, ventricular failure- should work together causes back up- decreased output- cardiac disrythmia- 100 beats for min.,
    • · left vent failure- decreased O2, SOB, dyspnea, orthopenia apnea, cough- dry then more productive, foamy, or clotty, hear crackles, dx: chest x-ray- left vent enlarged