cardiac Diseases

CARDIAC DISEASES
nCoronary Artery Disease
nMyocardial Infarction
nCongestive Heart Failure
nInfective Endocarditis
nCardiac Tamponade
nCardiogenic Shock

VASCULAR DISEASES
n Hypertension
n Buerger’s disease
n Aneurysm
n Varicose veins
n Deep vein thrombosis

CORONARY ARTERY DISEASE
n results from the focal narrowing of the large and medium-sized coronary arteries due to deposition of atheromatous plaque in the vessel wall

RISK FACTORS
1. Age above 45/55 and Sex- Males and post-menopausal females
2. Family History
3. Hypertension
4. DM
5. Smoking
6. Obesity
7. Sedentary lifestyle
8. Hyperlipedimia
MODIFIABLE RISK FACTORS
nSmoking
nHypertension
nDiabetes
nCholesterol abnormalities
PATHOPHYSIOLOGY
Fatty streak formation in the vascular intima

T-cells and monocytes ingest lipids in the area of deposition
Atheroma
narrowing of the arterial lumen
reduced coronary blood flow
myocardial ischemia

PATHOPHYSIOLOGY
nThere is decreased perfusion of myocardial tissue and inadequate myocardial oxygen supply
nIf 50% of the left coronary arterial lumen is reduced or 75% of the other coronary artery, this becomes significant
nPotential for Thrombosis and embolism

Heart attack (myocardial infarction or MI)
nHeart attack is when part of the heart muscle dies. This is usually caused by a blood clot (coronary thrombosis), which has blocked one of the coronary arteries supplying the heart and depriving the tissues of oxygen.
nTreatment for C.A.D involves the removal or treatment of risk factors.
n Sometimes procedures to enlarge or bypass coronary artery narrowing are required.
nIf Coronary Disease is not treated and the coronary artery becomes blocked the result may be a heart attack.
Coronary Artery Disease treatment
nPTCA (Percutaneous Transluminal Coronary Angioplasty) – one or more arteries are dilated with a balloon catheter
nCoronary stents – used instead of PTCA to eliminate the risk of acute coronary vessel occlusion and to improve long term patency
Coronary Artery Disease treatment
nAtherectomy – removes plaque from an artery by the use of cutting chamber on the inserted catheter or a rotating blade that pulverizes the plaque
nCoronary Artery Bypass Graft (CABG) – occluded arteries are bypassed with client’s own venous or arterial supply. (radial artery, greater saphenous, internal mammary)
Treatments for coronary disease - angioplasty
nCoronary angioplasty involves inserting a balloon into a diseased (blocked/narrowed) coronary artery through an artery in the groin or arm.
nCommonly a metal support (stent) is inserted into the artery to help keep it open.

Valve Replacements
Aortic Valve Replacement (AVR)
Mitral Valve Replacement (MVR)
An assortment of Replacement Valves

ANGINA PECTORIS
n Chest pain resulting from coronary atherosclerosis or myocardial ischemia
n Imbalance between O2 supply and demand
THREE COMMON TYPES OF ANGINA
nStable angina
nUnstable angina
nVariant angina
STABLE ANGINA
n Exertional angina
n occurs with activities involve exertion or emotional stress
n relieved by rest and drugs and the severity does not change
UNSTABLE ANGINA
n Pre infarction angina
n Occurs unpredictably during exertion and emotional stress, severity increases with time and pain may not be relieved by rest and drug
UNSTABLE ANGINA
nIs associated with coronary insufficiency
nLast longer then 15 minutes
nIs a symptom of worsening angina
VARIANT ANGINA
n Prinzmetal’s angina or vasospastic’s angina
n Results from coronary artery VASOSPASMS, may occur at rest
nMay be associated with ST segment elevation
OTHER TYPE OF ANGINA
nINTRACTABLE ANGINA is a chronic incapacitating angina that is unresponsive to treatment
nPOST INFARCTION ANGINA occurs after an MI , when residual ischemia may cause episodes of angina
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
nThe most characteristic symptom
nPAIN is described as mild to severe retrosternal pain, squeezing, tightness or burning sensation
nRadiates to the jaw, shoulders, neck, back and left arm
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
nPrecipitated by Exercise, Eating heavy meals, Emotions like excitement and anxiety and Extremes of temperature
nRelieved by REST and Nitroglycerin
ASSESSMENT FINDINGS
2. Diaphoresis
3. Nausea and vomiting
4. Cold clammy skin
5. Sense of apprehension and doom
6. Dizziness and syncope
LABORATORY FINDINGS
nECG may show normal tracing if patient is pain-free. Ischemic changes may show ST depression and T wave inversion
nCardiac catheterization
–Provides the MOST DEFINITIVE source of diagnosis by showing the presence of the atherosclerotic lesions

NURSING DIAGNOSIS
nDecreased cardiac output
nImpaired gas exchange
nActivity intolerance
nAnxiety

NURSING MANAGEMENT
1. Administer prescribed meds
nNitrates- to dilate the venous vessels decreasing venous return and to some extent dilate the coronary arteries
nAspirin- to prevent thrombus formation
nBeta-blockers- to reduce BP and HR
nCalcium-channel blockers- to dilate coronary artery and reduce vasospasm
NURSING MANAGEMENT
2. Teach the patient management of anginal attacks
nAdvise patient to stop all activities
nPut one nitroglycerin tablet under the tongue
nWait for 5 minutes
nIf not relieved, take another tablet and wait for 5 minutes
nAnother tablet can be taken (third tablet)
nIf unrelieved after THREE tabletsà seek medical attention
NURSING MANAGEMENT
3. Obtain a 12-lead ECG
4. Promote myocardial perfusion
nInstruct patient to maintain bed rest
nAdminister O2 @ 3lpm
nAdvise to avoid valsalva maneuvers
nProvide laxatives or high fiber diet to lessen constipation
nEncourage to avoid increased physical activities

NURSING MANAGEMENT
5. Assist in possible treatment modalities
nPTCA - to compress the plaque against the vessel wall, increasing the arterial lumen
nCABG - to improve the blood flow to the myocardial tissue

NURSING MANAGEMENT
6. Provide information to family members to minimize anxiety and promote family cooperation
7. Assist client to identify risk factors that can be modified
8. Refer patient to proper agencies

MYOCARDIAL INFARCTION
n Death of myocardial tissue in regions of the heart with abrupt interruption of coronary blood supply

PATHOPHYSIOLOGY
nInterrupted coronary blood flowà myocardial ischemia àanaerobic myocardial metabolism for several hoursà myocardial death à depressed cardiac function à triggers autonomic nervous system response à further imbalance of myocardial O2 demand and supply

MI
nDecrease O2 ischemia necrosis
nInfarction – evolves over several hours
n6 hours – blue and swollen
n48 hours – gray with yellow streaks and neutrophils
n8-10 days – granulation tissue forms
n2-3 mos – scar formation
LOCATION OF MI
nObstruction to L anterior descending artery – anterior or septal wall MI
nObstruction of the circumflex artery – posterior or lateral wall MI
nObstruction of right coronary artery – inferior wall MI
ETIOLOGY
1. CAD
2. Coronary vasospasm
3. Coronary artery occlusion by embolus and thrombus
4. Conditions that decrease perfusion- hemorrhage, shock
RISK FACTORS
1. Hypercholesterolemia
2. Smoking
3. Hypertension
4. Obesity
5. Stress
6. Sedentary lifestyle
7. DM
ASSESSMENT
1. CHEST PAIN
nChest pain is described as severe, persistent, crushing substernal discomfort
nRadiates to the neck, arm, jaw and back
ASSESSMENT
1. CHEST PAIN
nOccurs without cause, primarily early morning
nNOT relieved by rest or nitroglycerin
nLasts 30 minutes or longer

ASSESSMENT
2. Dyspnea
3. Diaphoresis
4. cold clammy skin
5. N/V
6. restlessness, sense of doom
7. tachycardia or bradycardia
8. hypotension
9. dysrhythmias
DIAGNOSTICS
nECG- the ST segment is ELEVATED, T wave inversion, presence of Q wave
nMyocardial enzymes- elevated CK-MB, LDH and Troponin levels
nCBC- may show elevated WBC count
nTest after the acute stage- Exercise tolerance test, thallium scans, cardiac catheterization

NURSING DIAGNOSIS
n Pain
n Decreased cardiac output
n Impaired gas exchange
n Activity intolerance
n Altered tissue perfusion
n Constipation
NURSING INTERVENTIONS
1. Provide Oxygen at 2 lpm, Semi-fowler’s
2. Administer medications
–Morphine to relieve pain
– nitrates, thrombolytics, aspirin and anticoagulants
–Stool softener and hypolipidemics
NURSING INTERVENTIONS
3. Minimize patient anxiety
–Provide information as to procedures and drug therapy
–Allow verbalization of feelings
–Morphine can be administered
4. Provide adequate rest periods
–Bed rest during acute stage

NURSING INTERVENTIONS
5. Minimize metabolic demands
–Provide soft diet
–Provide a low-sodium, low cholesterol and low fat diet
6. Assist in treatment modalities such as PTCA and CABG

NURSING INTERVENTIONS
7. Monitor for complications of MI- especially dysrhythmias, since ventricular tachycardia can happen in the first few hours after MI
8. Provide client teaching

MANAGEMENT
1. ANALGESIC
–The choice is MORPHINE
–It reduces pain and anxiety
–Relaxes bronchioles to enhance oxygenation
MANAGEMENT
2. ACE inhibitors
–Prevents formation of angiotensin II
–Limits the area of infarction
3. Thrombolytic therapy
–Streptokinase, Alteplase
–Dissolve clots in the coronary artery allowing blood to flow
NURSING INTERVENTIONS AFTER ACUTE EPISODE
1. Maintain bed rest for the first 3 days
2. Provide passive ROM exercises
3. Progress with dangling of the feet at side of bed

NURSING INTERVENTIONS AFTER ACUTE EPISODE
4. Proceed with sitting out of bed, on the chair for 30 minutes TID
5. Proceed with ambulation in the roomà toiletà hallway TID
NURSING INTERVENTIONS AFTER ACUTE EPISODE
6. Cardiac rehabilitation
nTo extend and improve quality of life
nPhysical conditioning
nPatients who are able to walk 3-4 mph are usually ready to resume sexual activities
CHF
n A syndrome of congestion of both pulmonary and systemic circulation caused by inadequate cardiac function and inadequate cardiac output to meet the metabolic demands of tissues
CHF
nInability of the heart to pump sufficiently
nThe heart is unable to maintain adequate circulation to meet the metabolic needs of the body
CHF
This can happen acutely or chronically
nAcuteà in Myocardial infarction

nChronicà cardiomyopathies
ETIOLOGY
1. CAD
2. Valvular heart diseases
3. Hypertension
4. MI
5. Cardiomyopathy
6. Lung diseases
7. Post-partum
8. Pericarditis and cardiac tamponade



New York Heart Association
nCLASS I
nCLASS II
nCLASS III
nCLASS IV
CLASS I
nOrdinary physical activity does NOT cause chest pain and fatigue
nNo pulmonary congestion
nAsymptomatic
nNO limitation of ADLs

CLASS II
nSLIGHT limitation of ADLs
nNO symptom at rest
nSymptoms with INCREASED activity
nBasilar crackles

CLASS III
nMarkedly limitation on ADLs
nComfortable at rest BUT symptoms present in LESS than ordinary activity
CLASS IV
nSYMPTOMS are present at rest
TYPES OF CHF
nLeft Ventricular failure/ Right ventricular failure
nForward failure/ Backward failure
nLow output failure/ High output failure
nSystolic failure/ Diastolic failure

TYPES OF FAILURES
nForward failure – inadequate output of the affected ventricles causes decreased perfusion to vital organs
nBackward failure – blood backs up behind the affected ventricle causing increased atrial pressure
nLow output failure – not enough CO to meet the body demands
TYPES OF FAILURES
nHigh output failure – heart works hard to meet the demands of the body
nSystolic failure – problems with contraction and ejection of blood
nDiastolic failure – problems with relaxation and filling with blood

LVHF AND RVHF
n2 ventricles represents 2 separate pumping system, it is possible for one to fail for a short period of time
nBegins with LV failure then progresses to both
PATHOPHYSIOLOGY
LEFT Ventricular pump failure

back up of blood into the pulmonary veins

increased pulmonary capillary pressure

pulmonary congestion (edema)

Pulmonary manifestations
PATHOPHYSIOLOGY
LEFT ventricular failure

Decreased cardiac output

Decreased perfusion to the brain, kidney and other tissues

Cerebral anoxia, fatigue, oliguria, dizziness
PATHOPHYSIOLOGY

RIGHT ventricular failure

blood pooling in the venous circulation

increased hydrostatic pressure

peripheral edema

PATHOPHYSIOLOGY

RIGHT ventricular failure

Venous blood pooling

venous congestion in the kidney, liver and GIT

LEFT SIDED CHF
ASSESSMENT FINDINGS
nEvident in the pulmonary system
nCough with Pinkish, frothy sputum
nDyspnea on exertion, activity intolerance, PND, Orthopnea
nPulmonary crackles/rales
nTachycardia
LEFT SIDED CHFASSESSMENT FINDINGS
nDecreased peripheral pulses, Cool extremities
nPallor, Cyanosis
nFatigue
n Signs of cerebral anoxia, confusion, disorientation
n pulsus alternans
RIGHT SIDED CHFASSESSMENT FINDINGS
nEvident in systemic circulation
nPeripheral dependent, pitting edema
nWeight gain
nDistended neck vein
nAscites, RUQ pain, organomegaly, bloating

RIGHT SIDED CHFASSESSMENT FINDINGS
nBody weakness
nAnorexia, nausea
nPulsus alternans
nNocturia - blood moves from interstitial space to the intravascular space and is excreted

LABORATORY FINDINGS
nCXR - cardiomegaly
nECG - Cardiac hypertrophy
n2D-Echo - hypokinetic heart
nABG and Pulse oximetry - decreased O2 saturation
nPCWP is increased in LEFT sided CHF and CVP is increased in RIGHT sided CHF
IMMEDIATE NURSING INTERVENTIONS
nPlace client in high fowler’s position
nAdminister O2 in high concentration
nPrepare for intubation and ventilator support
nAssess patient's cardio-pulmonary status, LOC, signs of organomegaly
IMMEDIATE NURSING INTERVENTIONS
nMonitor VS, I & O, peripheral pulses, weight
nInsert IFC
nHook to cardiac monitor
nAnalyze ABG and electrolyte values
nAdminister meds as prescribed
PHARMACOLOGIC INTERVENTION
nMorphine SO4 – sedation and vasodilation
nDiuretics – reduce pre load, enhance Na and H2O excretion
nDigitalis – improve contractility and CO
nBronchodilators
PHARMACOLOGIC INTERVENTION
nDobutamine and dopamine – inotropic effect and increase SV
nVasodilators – decrease afterload, decrease VR

VASCULAR DISEASES
General Measures to Improve Peripheral Circulation
1. Implement Regular Physical Activity – to facilitate movement of venous blood
2. Eliminate cigarette smoking- to prevent vasoconstriction
3. Control hyperlipidemia and cholesterol levels- to prevent the progression of atherosclerosis
General Measures to Improve Peripheral Circulation
4. Avoid cold environmental temperature
5. Teach clients to assess fingers and toes daily for circulatory adequacy: Check the peripheral pulses, capillary refill and temp
6. Report break in the skin
VENOUS THROMBOSIS
nThrombus – associated with inflammatory process
nWhen thrombus develops, inflammation occurs, thickening the vein wall and leading to embolization

RISK FACTORS
nVenous stasis – varicose vein, immobility
nHypercoagubility disorders
nInjury to venous walls – IV injection, fracture
nFollowing surgery
nUse of OCP’s, pregnancy, smoking
TYPES
nPhlebitis – vein inflammation
nThrombophlebitis – thrombus with inflammation
nPhebothrombus – thrombus without inflammation
nDeep vein thrombophlebitis – risk of pulmonary embolism

PHLEBITIS
nRed, warm, tender, swollen area
nApply warm moist soaks
nAssess temperature
nAssess signs of complications – tissue necrosis, infection, pulmonary embolus

DVT
nInflammation of the deep veins of the lower extremities and the pelvic veins
nThe inflammation results to formation of blood clots in the area
nPULMONARY EMBOLISM
ASSESSMENT
nCalf or groin tenderness
nPain with or without swelling
nPositive HOMAN’s SIGN
nWarm skin and tender touch

HOMAN’S SIGN
nThe foot is FLEXED upward (dorsiflexed) , there is a sharp pain felt in the calf of the legà indicative of venous inflammation
LABORATORY DIAGNOSIS
nVenography
nDuplex scan

DVT- Deep Vein Thrombosis
nMedical management
–Antiplatelets- aspirin
–Anticoagulants
–Vein stripping and grafting
–Anti-embolic stockings
NURSING INTERVENTION
nProvide measures to avoid prolonged immobility
–Repositioning Q2
–Provide passive ROM
–Early ambulation
nProvide skin care to prevent the complication of leg ulcers
NURSING INTERVENTION
nDo not massage the extremities
nElevate the affected extremity above the heart level
nAvoid using pillow under the knees
nProvide thigh-high compression or anti-embolic stockings
NURSING INTERVENTION
nWarm compress as prescribed
nPalpate site gently, monitoring for warmth and edema
nMonitor for signs of pulmonary emboli
nMeasure and record circumferences of thigh and calves
nAdministers med as ordered

PHARMACOLOGIC THERAPY
nThrombolytic therapy (tpa) – initiated within 5 days after the onset of symptoms
nAdminister heparin – monitor aPTT
nAdminister warfarin – monitor PT and INR
nAdminister analgesics and diuretics
CLIENT TEACHINGS
nInstruct client concerning hazards of anticoagulation therapy
nRecognize signs and symptoms of bleeding
nElevate legs 10-20 min every few hours
nAvoid prolong sitting or standing, crossed legs when seated
nAvoid smoking, OTC and Wear medic alert bracelet
nInstruct the importance of follow up and lab work ups
VARICOSE VEINS
n Dilated veins usually in the lower extremities that appears darkened and tortuous
nVein walls weaken and dilate, valves become incompetent
Venous diseases

PATHOPHYSIOLOGY
nPregnancy
nProlonged standing or sitting
–Factors à venous stasisà increased hydrostatic pressure à edema

ASSESSMENT
nTortuous superficial veins on the legs
nLeg pain
n feeling or fullness or heaviness
nDependent or ankle edema
LABORATORY DIAGNOSIS
nVenography
nDuplex scan
nPletysmography
SCLEROTHERAPY
nSolution is injected to the vein followed by application of a pressure dressing
nI & D of trapped blood in the sclerosed vein after 14-21 days then application of pressure dressing for 12-18hours
VEIN STRIPPING
nVein is >4mm or in clusters
nAssist physician with vein marking
nMaintain elastic bandages post op and elastic stocking after bandage removal
nMonitor VS, bleeding and NVS
nElevates leg above heart level
nEncourage ROM
nAvoid leg dangling

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
nRefers to arterial insufficiency of the extremities usually secondary to peripheral ATHEROSCLEROSIS.
nUsually found in males age 50 and above
nTissue damage occurs below the level of occlusion (legs)
Non-Modifiable Risk factors
1. Age
2. gender
3. family predisposition
Modifiable RISK FACTORS
1. Smoking
2. HPN
3. Obesity
4. Sedentary lifestyle
5. DM
6. Stress

ASSESSMENT FINDINGS
1. INTERMITTENT CLAUDICATION- the hallmark of PAOD
nThis is PAIN described as numbness, aching, cramping or fatiguing which awakens client at night
nThis pain is RELIEVED by placing the extremity on the dependent portion
nThis commonly affects the muscle group below the arterial occlusion

PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
2. Progressive pain on the extremity as the disease advances
3. Sensation of cold and numbness of the extremities
4. Skin is pale when elevated and cyanotic and ruddy when placed on a dependent position
5. Muscle atrophy, leg ulceration and gangrene

PAOD
6. Signs of arterial ulcer formation occurring or between the toes or on the upper aspect of the foot that are characterized as painful
7. BP in the thigh, ankle and calf are lower than Upper Ex (N )
8. Absent or decreased peripheral pulses
DIAGNOSIS
1. Unequal pulses between the extremities
2. Duplex ultrasonography
3. Doppler flow studies

NURSING INTERVENTIONS
nAssess pain, signs of ulcer or gangrene formation
nObtain BP measurements
nAssist in developing an individualized exercise program and encourage prescribed exercises

NURSING INTERVENTIONS
nElevate feet at rest in patient with edema but not more than above the heart level
nAvoid crossing of legs, smoking, caffeine, extreme cold (vasoconstriction)
nWear socks and shoes for insulation
NURSING INTERVENTIONS
nAvoid application of direct heat due to decreased sensation
nInstruct client to check skin integrity daily
nInstruct client in the use of antiplatelet and hemorrheologic meds as prescribed
PHARMACOLOGIC INTERVENTIONS
nPentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles
nCilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation
SURGICAL INTERVENTIONS
nBypass surgery
nLaser assisted angioplasty
nAtherectomy
n PTCA
RAYNAUD’S DISEASE
nA vasospasms of arterioles and arteries of upper and lower extremities
nAttacks are intermittent VASOCONSTRICTION of cutaneous vessel that results in coldness, pain and pallor of the fingertips, toes, ears and cheeks

RAYNAUD’S DISEASE
nCause : UNKNOWN
nMost commonly affects WOMEN, 16- 40 years old
ASSESSMENT FINDINGS
nBlanching of the extremities, followed by cyanosis during vasoconstriction
nReddened tissue when vasospasm is relieved
nNumbness, tingling sensation, swelling, cold temperature of affected body part

COLOR CHANGES
nPallor- due to vasoconstriction, then à
nBlue- due to pooling of Deoxygenated blood
nRed- due to exaggerated reflow or hyperemia

NURSING INTERVENTION
nInstruct patient to avoid situations that may be stressful
nInstruct to avoid exposure to cold and remain indoors when the climate is cold
nInstruct to avoid all kinds of nicotine
nInstruct about safety and careful handling of sharp objects
nAdminister vasodilators as prescribed
PHARMACOLOGICAL MANAGEMENT
nDrug therapy with the use of CALCIUM channel blockers
–To prevent vasospasms
BUERGER’S DISEASE
nThromboangiitis obliterans
nA disease characterized by recurring inflammation of the medium and small arteries and veins of the lower extremities
nDistal UEX and LEX are commonly affected
BUERGER’S DISEASE
nCause is UNKNOWN
nProbably an Autoimmune disease
nOccurs in MEN ages 20-35
nRISK FACTOR: SMOKING!

PATHOPHYSIOLOGY
nInflammation of the arteries and veinsà thrombus formationà occlusion of the vessels
BUERGER’S DISEASE

ASSESSMENT FINDINGS
nIntermittent claudication
nIschemic pain occurring at the digits while at rest
nIntense RUBOR (reddish-blue discoloration), progresses to CYANOSIS as disease advances
nCool, numb, tingling sensation, paresthesias
nDecreased pulse on distal extremities
nDevelopment of ulceration

LABORATORY DIAGNOSIS
1. Duplex ultrasonography
2. Contrast angiography

NURSING INTERVENTION
1. Assist in the medical and surgical management
–Bypass graft
–amputation
2. AVOID smoking
3. Monitor pulses
4. Administer vasodilator as prescribed

POST AMPUTATION CARE
nElevate stump for the FIRST 24 HOURS to minimize edema and promote venous return
nPlace patient on PRONE position after 24 hours several times a day
nAssess skin for bleeding and hematoma
nWrap the extremity with elastic bandage

HYPERTENSION
nA systolic BP greater than 139 mmHg and a diastolic pressure greater than 89 mmHg over a sustained period, based on two or more BP measurements.

PRIMARY HYPERTENSION
nEssential
nNo known cause

SECONDARY HYPERTENSION
nDue to other conditions
nPheochromocytoma, renovascular hypertension, Cushing’s, Conn’s , SIADH

JNC-VII CLASSIFICATION

PATHOPHYSIOLOGY

nMulti-factorial etiology
BP= CO (SV X HR) x TPR
Any increase in the above parameters will increase BP
RISK FACTORS
1. Smoking
2. Hyperlipidemia
3. DM
4. Age older than 60
5. Gender- Male and post menopausal women
6. Family History

PARAMETERS THAT WILL INCREASE BP
nIncreased sympathetic activity
nIncreased absorption of Sodium, and water in the kidney
nIncreased activity of the RAAS
nIncreased vasoconstriction of the peripheral vessels
nInsulin resistance

ASSESSMENT FINDINGS
nAsymptomatic
nHeadache
nVisual changes
nchest pain
ndizziness
nN/V
nFlushed face
nTinnitus and epistaxis
DIAGNOSIS
1. Health history and PE
2. Routine laboratory- urinalysis, ECG, lipid profile, BUN, serum creatinine , FBS
3. Other lab- CXR, creatinine clearance, 24-huour urine protein

GOALS OF TREATMENT
nReduce BP
nPrevent or lessen end organ damage
MANAGEMENT
nWeight reduction or maintain ideal weight
nLifestyle modification
nDiet therapy – limit Na intake ro 2g/ day, mod intake of caffeine and alcohol
nAvoid smoking
nInitiation of regular exercise
nRelaxation techniques and biofeedback mechanism

PHARMACOLOGIC MANAGEMENT
nDiuretics
nBeta blockers
nCalcium channel blockers
nACE inhibitors
nA2 Receptor blockers
nVasodilators

NURSING INTERVENTIONS
1. Provide health teaching to patient
nTeach about the disease process
nElaborate on lifestyle changes
nAssist in meal planning to lose weight
nProvide list of LOW fat , LOW sodium diet of less than 2-3 grams of Na/day
nLimit alcohol intake to 30 ml/day
nRegular aerobic exercise
nAdvise to completely Stop smoking

NURSING INTERVENTIONS

2. Provide information about anti-hypertensive drugs
nInstruct proper compliance and not abrupt cessation of drugs even if pt becomes asymptomatic/ improved condition
nInstruct to avoid over-the-counter drugs that may interfere with the current medication

NURSING INTERVENTIONS
3. Promote Home care management
nInstruct regular monitoring of BP
nInvolve family members in care
nInstruct regular follow-up



HYPERTENSIVE CRISIS
nRequires immediate reduction of BP
nAcute and life threatening condition
nTarget organ damage occurs quickly
nDeath can be caused by stroke, renal failure, cardiac disease