Cardiovascular and Respiratory System Disorders

Chapter 40

Cardiovascular and Respiratory System Disorders

LEARNING OUTCOMES:

• Define the key terms and key abbreviations listed in this chapter
• Describe congenital heart defects
• Identify the risk factors for hypertension
• Describe hypertension, its signs and symptoms, complications, and treatment
• Describe coronary artery disease and its risk factors
• Identify the complications of coronary artery disease
• Describe cardiac rehabilitation
• Describe angina, its signs and symptoms, and treatment
• Describe myocardial infarction, its signs and symptoms, and treatment
• Describe heart failure, its signs and symptoms, and treatment
• Describe chronic obstructive pulmonary disease, its signs and symptoms, and treatment
• Explain the difference between a cold and influenza
• Explain how influenza is treated
• Describe pneumonia, its signs and symptoms, and treatment
• Describe tuberculosis, its signs and symptoms, and treatment

CARDIOVASCULAR DISORDERS

Problems occur in the heart or blood vessels.

With hypertension, the resting blood pressure is too high.

•The systolic pressure is 140 mm Hg or higher or the diastolic pressure is 90 mm Hg or higher.

•Causes include:

Narrowed blood vessels

Kidney disorders

Head injuries

Some pregnancy problems

Adrenal gland tumors

•Hypertension can lead to:

Stroke

Hardening of the arteries

Heart attack

Heart failure

Kidney failure

Blindness

•Life-style changes can lower blood pressure.

A diet low in fat and salt

A healthy weight

Regular exercise

Not smoking

Limiting alcohol and caffeine

Managing stress and sleeping well

•Certain drugs can lower blood pressure.

Coronary artery disease (CAD, coronary heart disease, heart disease)

•The coronary arteries are in the heart.

•In CAD, one or all of the coronary arteries become hardened and narrow.

•The most common cause is atherosclerosis.

•The major complications of CAD are:

Angina

Myocardial infarction (heart attack)

Irregular heartbeats

Sudden death

•The more risk factors, the greater the chance of CAD and its complications.

•These risk factors cannot be controlled:

Gender (Men are at greater risk than women.)

Age (Risk increases with age.)

Family history

Race (African-Americans are at greater risk than other groups.)

•These factors can be controlled:

Being overweight

Lack of exercise

High blood cholesterol

Hypertension

Smoking

Diabetes

Stress

•The goals of treatment are to:

Relieve symptoms

Slow or stop atherosclerosis

Lower the risk of blood clots forming

Widen or bypass clogged arteries

Reduce cardiac events

•Persons with CAD need to:

Quit smoking, exercise, and reduce stress

Eat a healthy diet

If overweight, lose weight

•Some persons need drugs to:

Decrease the heart’s workload and relieve symptoms

Prevent a heart attack or sudden death

Delay the need for medical and surgical procedures

•Persons with complications from CAD may need cardiac rehabilitation.

Cardiac rehab has two parts:

–Exercise training

–Education, counseling, and training

Angina (pain) is chest pain.

•It is from reduced blood flow to part of the heart muscle (myocardium).

•Chest pain is described as tightness, pressure, squeezing, or burning in the chest.

•Symptoms can be relieved.

Rest often relieves symptoms in 3 to 15 minutes.

A nitroglycerin tablet is taken when angina occurs.

Some persons have nitroglycerin patches.

•Things that cause angina are avoided.

•Exercise programs are supervised by the doctor.

•Chest pain lasting longer than a few minutes and not relieved by rest and nitroglycerin may signal heart attack. The person needs emergency care.

Myocardial infarction (MI)

•With MI, part of the heart muscle dies.

Sudden cardiac death (sudden cardiac arrest) can occur.

•MI also is called:

Heart attack

Acute myocardial infarction (AMI)

Acute coronary syndrome (ACS)

Coronary

Coronary thrombosis

Coronary occlusion

•CAD, angina, and previous MI are risk factors.

•MI is an emergency.

•Efforts are made to:

Relieve pain

Restore blood flow to the heart

Stabilize vital signs

Give oxygen

Calm the person

Prevent life-threatening problems

•If the person survives:

He or she may need medical or surgical procedures to open or bypass the diseased artery.

Cardiac rehabilitation is needed.

Heart failure (congestive heart failure [CHF])

•Heart failure occurs when the heart is weakened and cannot pump normally.

•When the left side of the heart cannot pump blood normally, blood backs up into the lungs.

A very severe form of heart failure is pulmonary edema (fluid in the lungs).

•When the right side of the heart cannot pump blood normally, blood backs up into the venous system.

•Common causes of heart failure are:

CAD

MI

Hypertension

Age

Diabetes

Irregular heart rhythms

Damaged heart valves

Kidney disease

• Treatment involves:

Drugs are ordered to strengthen the heart.

Drugs are ordered to reduce the amount of fluid in the body.

A sodium-controlled diet is ordered.

Oxygen is given.

Semi-Fowler’s position is preferred for breathing.

The person must reduce the risk factors for CAD.

If acutely ill, the person needs hospital care.

RESPIRATORY DISORDERS

The respiratory system brings oxygen (O2) into the lungs and removes carbon dioxide (CO2) from the body.

Respiratory disorders interfere with this function and threaten life.

Chronic obstructive pulmonary disease (COPD)

•Chronic bronchitis, emphysema, and asthma are grouped under COPD.

•Risk factors for COPD include:

Cigarette smoking

Pipe, cigar, and other smoking tobaccos

Exposure to second-hand smoke

•Not smoking is the best way to prevent COPD.

•COPD has no cure.

•COPD affects the airways and alveoli.

Chronic bronchitis occurs after repeated episodes of bronchitis.

•Bronchitis means inflammation of the bronchi.

•Smoking is the major cause.

•Infection, air pollution, and industrial dusts are risk factors.

•Smoker’s cough in the morning is often the first symptom.

•Treatment involves:

The person must stop smoking.

Oxygen therapy and breathing exercises are often ordered.

Respiratory tract infections are prevented.

–If one occurs, the person needs prompt treatment.

In emphysema, the alveoli enlarge and become less elastic.

•Some air is trapped in the alveoli when exhaling.

O2 and CO2 exchange cannot occur in affected alveoli.

•Smoking is the most common cause.

•Air pollution and industrial dusts are risk factors.

•The person has shortness of breath and a cough.

•Breathing is easier when the person sits upright and slightly forward.

•Treatments

The person must stop smoking.

Respiratory therapy, breathing exercises, oxygen, and drug therapy are ordered.

With asthma, the airway becomes inflamed and narrow.

•Extra mucus is produced.

•Signs and symptoms include:

Dyspnea

Wheezing and coughing

Pain and tightening in the chest

•Asthma usually is triggered by allergies.

•Sudden attacks (asthma attacks) can occur.

•Asthma is treated with drugs.

Severe attacks may require emergency care.

Repeated attacks can damage the respiratory system.

Influenza (flu)

•Influenza is a respiratory infection.

•Caused by viruses, flu season is usually from November through March.

•Most deaths from flu occur in older persons.

•Treatment involves fluids, rest, and relief of symptoms.

•Coughing and sneezing spread flu viruses.

Standard Precautions are followed.

•The flu vaccine is the best way to prevent the disease.

•The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for persons who:

Are 50 years of age and older

Have chronic heart, lung, or kidney diseases

Have diabetes

Have immune system problems

Have a severe form of anemia

Will be more than 3 months pregnant during the flu season

Are nursing center or assisted-living residents

Are in close contact with children 0 to 23 months of age

Pneumonia

•Pneumonia is an inflammation and infection of lung tissue.

Affected tissues fill with fluid.

•Bacteria, viruses, and other microbes are causes.

•Microbes reach the lungs in these ways:

Being inhaled

Aspirated

Carried in the blood

•Children under 2 years of age and adults over 65 years of age are at risk.

•Older adults are at great risk of dying from the disease.

•Factors that increase the risk of pneumonia include:

Smoking

Aging

Stroke

Bedrest

Immobility

Chronic diseases

Tube feedings

•Treatment may include:

Drugs for infection and pain

Increased fluid intake to treat fever and to thin secretions

Intravenous therapy and oxygen

Semi-Fowler’s position to ease breathing

•Rest is important.

•Standard Precautions are followed.

•Isolation Precautions are used depending on the cause.

•Mouth care is important.

•Frequent linen changes are needed because of fever.

Tuberculosis (TB) is a bacterial infection in the lungs.

•It also can occur in other parts of the body.

•If TB is not treated, the person can die.

•TB is spread by airborne droplets with coughing, sneezing, speaking, singing, or laughing.

•Those who have close, frequent contact with an infected person are at risk.

•Risk factors include:

Living in close, crowded areas

Age

Poor nutrition

HIV infection

•TB can be present in the body but not cause signs and symptoms.

Only persons with an active infection can spread the disease to others.

•Chest x-rays and TB testing can detect the disease.

•Treatment involves giving drugs for TB.

•Standard Precautions and Isolation Precautions are needed.

•The person must cover the mouth and nose with tissues when sneezing, coughing, or producing sputum.

Tissues are flushed down the toilet, placed in a biohazard bag, or placed in a paper bag and burned.

•Hand washing after contact with sputum is essential.