Common nursing diagnosis and care of cardiovascular disorder

Acute pain related to myocardial ischemia / reduce coronary blood flow as evidenced by facial expressions

Relieve Pain

Assess the patient’s condition.

To monitor vital signs.

Assessing pain level.

Noting location, duration, intensity, timing etc. of pain.

To assess factors triggering and relieving pain.

Provide Fowler or semi-Fowler position to the patient so that the lungs can expand well.

Providing patient mind diversion therapy. So that the patient’s attention is diverted from the pain.

Providing relaxation therapy to the patient.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain records and reports.

Decrease cardiac output related to decrease cardiac contractility / reduced preload afterload contractility / decrease coronary blood flow as evidenced by increased heart rate

Maintain Cardiac Output / Improve Cardiac Output

Assess the patient’s condition.

To monitor vital signs.

Monitor cardiovascular status.

Monitoring the ECG pattern.

To auscultate heart sound and rhythm.

Assessing the peripheral pulse.

To monitor hemodynamic parameters.

Maintaining intake output chart.

Monitor urine output every hour.

Providing patient with Fowler position or High Fowler position.

Provide IV fluid as prescribed by the doctor.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain record report.

Ineffective cardiac tissue perfusion / impaired tissue perfusion related to reduce coronary blood flow as evidenced by decreased cardiac output, increased heart rate

Promoting Adequate Tissue Perfusion / Improve Cardiac Tissue Perfusion

Assess the patient’s condition.

To monitor vital signs.

Assess the patient’s skin for gross, moist sinusitis.

Assessing fluid volume status.

Checking skin temperature, peripheral pulse, capillary refill. With the help of which it can be known whether tissue perfusion is present or not.

Provide bed rest to the patient.

Administer oxygen therapy.

Provide mechanical ventilation if required.

Provide fluid resuscitation.

Administering medicine prescribed by a doctor.

Monitor for side effects and effectiveness of medications.

To maintain record report.

Impaired gas exchange related to chest surgery / interruption in blood flow to the pulmonary alveoli as evidenced by dyspnea, cynosis

Improve gas exchange

Assess the patient’s condition.

To monitor vital signs.

To monitor respiratory rate, rhythm, arterial blood gas, tidal volume, peak inspiratory pressure, extubation parameters.

Assess skin, mucus membrane, nail bed for sinusitis.

To auscultate breath sounds.

Providing the patient with semi-fowler or fowler position.

Provide bed rest to the patient.

Restrict activity until the patient is hemodynamically stable.

Giving knowledge to the patient about deep breathing exercises.

Provide supplemental oxygen to the patient.

Administer the medicine prescribed by the doctor.

To maintain records and reports.

Ineffective thermoregulation related to infection as evidenced by increased body temperature

Maintain Body Temperature

Assess the patient’s condition.

To monitor vital signs.

Monitor temperature every two to four hours.

Maintaining the temperature of the patient’s room.

Provide cold application to the patient.

If the patient feels cold, avoid cold application and provide blanket.

Maintaining adequate hydration.

Ask the patient to intake oral fluids and administer IV fluids.

Administer antipyretic and antibiotic medicine as per doctor’s prescription.

To maintain records and reports.

Anxiety related to disease condition, uncertain prognosis, hospitalization as evidence by verbalization, restlessness, agitation

Reduce Anxiety

Assess the patient’s condition.

Assess for signs of anxiety such as restlessness, sleeplessness.

Paying attention to the psychological needs of the patient and listening carefully to the patient.

Encouraging the patient to express his feelings, discomfort and anxiety.

To solve all doubts and queries of patients.

Providing knowledge to the patient about his condition and treatment so that his anxiety is removed and the patient becomes confident.

Providing psychological support to the patient.

Providing mind diversional therapy and recreational therapy to patients.

Administer an antianxiety agent. Activity intolerance related to fatigue,

Dyspnea as evidenced by shortness of breath, abnormal heart rate

Inhas Activity Level (Increase Activity Level)

Assess the patient’s condition.

Checking the patient’s activity level.

Provide bed rest to the patient initially.

Then gradually anchor the patient to range of motion exercises.

Assisting the patient with his activities.

2 Provide rest to the patient between activities.

Checking the patient for any breathing difficulty, palpitation during activity.

If present, stop the patient’s activity and provide rest.

Ask the patient to avoid lifting heavy objects.

Asking to avoid activities that strain the heart.

Knowledge deficit related to disease condition and it’s prognosis as evidenced by communication with patient, patient questioning about him/her condition

Improve Knowledge Level

Assess the patient’s condition.

Assessing the patient’s knowledge of the disease condition and its treatment.

To provide knowledge to the patient about the disease condition and its prognosis.

Providing knowledge in a language the patient can understand.

To resolve patient’s doubts and queries.

COMMON CARDIOVASCULAR AND HEMATOLOGICAL DISORDERS

• Explain coronary artery disease

Coronary artery disease is also known as ‘atherosclerotic heart disease’.

Coronary artery disease is a common type of heart disease. In which a plaque (atheroma) develops in the innermost layer of the coronary artery that supplies blood to the heart i.e. plaque deposits.

Due to which the coronary artery becomes narrowing and finally blockage is seen in it.

As a result of which there is a decrease in coronary blood flow so that the heart does not get enough blood supply and oxygen supply i.e. myocardial ischemia is observed and finally conditions like heart attack are observed.

• Define angina pectoris

Angina is also known as ‘ischemic chest pain’.

Angina pectoris is the medical term used for ‘chest pain’ and ‘discomfort’ experienced due to coronary heart disease.

Angina is not a disease but is a symptom of coronary artery disease.

Plaque deposits in the coronary arteries cause narrowing, which prevents adequate blood and oxygen from reaching the heart muscles and causes chest pain.

Write types of angina pectoris

✓ Stable (Classic) Angina: In stable angina, chest pain occurs when exertion, exercise or any stressful activity is done. This pain can be relieved by rest and medication.

✓ Unstable Angina: Unstable angina is the less common and most severe type. In which chest pain is seen during rest or minimal exertion. Hence it cannot be relieved by rest and medication. This is an impending sign of a heart attack.

✓ Variant Angina: Variant angina also known as ‘Princemetal’ and ‘Vasospastic Angina’ is characterized by chest pain due to spasm in the coronary arteries. This pain is seen during the period of rest and this pain is seen during the midnight and early morning time.

✓ Refractory Angina: Refractory angina is a severe and persistent form of angina in which chest pain persists despite medication, lifestyle changes, angioplasty and bypass surgery. So for treatment, Enhanced External Counter Pulsation (EECP), Spinal Cord Stimulation, Heart Transplantation is done.

✓ Silent Ischemia: In silent ischemia the patient does not feel pain i.e. there are subjective data absences. But it can be determined with the help of ECG, exercise stress test, Holter monitoring.

Write causes of angina pectoris

Deposition of Plaque in Coronary Arteries

Coronary artery spasm

Arterial embolism

Narrowing of heart valves (aotic stenosis)

Hypertrophic cardiomyopathy

Severe anemia

Write sign and symptoms seen in angina pectoris

Chest pain

During this pain feels like pressure, tightness, squeezing, heaviness, burning.

The pain radiates to the neck, jaw, shoulder, arm and back.

Discomfort

Shortness of breath

Fatigue

weakness

swatting

Nozia

Vomiting

Write diagnostic evaluation of angina pectoris

History Collection

Physical Examination

Electrocardiogram (ECG/EKG)

Echocardiogram

Coronary angiography

Exercise stress test

Blood tests – cholesterol level, troponin, creatine kinase (CK-MB), myoglobin

Write medical management of angina pectoris

Oxygen therapy: Administering oxygen through a nasal cannula or mask. So that the heart muscles get oxygen.

Vasodilator: Nitroglycerin drug is used as a vasodilator drug. Which dilates blood vessels so that blood flow can be improved. (Angina can be relieved by nitroglycerin so nitroglycerin is the drug of choice)

Antiplatelet: Antiplatelet drugs thin the blood and prevent blood clots. Aspirin for example.

Beta blockers: Provide beta blockers to reduce heart work load. Which slows the heart rate and decreases the blood pressure. For example propanolol, atenolol

Calcium channel blockers: Calcium channel blockers block the entry of calcium into the heart muscle so that the muscle relaxes and helps the arteries to widen and lower blood pressure. E.g. Amlodipine, nifedipine

ACE inhibitors: ACE inhibitors prevent the conversion of angiotensin I to angiotensin II and promote diuresis, vasodilation and reduce cardiac workload. For example enalapril, captopril

Statins: Statins decrease cholesterol levels and reduce the risk of plaque buildup in the arteries. For example atorvastatin.

Write surgical management of angina pectoris

✓ Coronary artery bypass grafting (CABG)

In CABG, a new route is created or bypassed for a narrowed or blocked coronary artery. In which healthy blood vessels are harvested from any part of the body such as chest, leg, arm and these harvested blood vessels are attached to the coronary artery and the blocked part is bypassed and normal blood flow is restored. CABG is mainly preferred in multiple coronary artery blockage conditions. Also CABG is done when medication and angioplasty fail.

✓ Percutaneous transluminal coronary angioplasty (PTCA)

PTCA is a minimally invasive surgical procedure used to open narrowed and blocked coronary arteries. In which a balloon attached to a catheter is inserted into the narrowing artery, the balloon is then inflated so that the artery widens and the plaque flattens against the artery wall, thereby improving coronary blood flow.

✓ Atherectomy Atherectomy is a surgical procedure used to remove plaque deposited in an artery. In this procedure, a small cutting device, blade, laser or drill is attached to the catheter and inserted into the artery to cut the plaque and remove the plaque to increase coronary blood flow. Methods like directional, rotational, laser are used in atherectomy.

✓ Coronary stent A coronary stent is a small mesh-like tube or artificial support device made of metal or polymer. In which the StentMe balloon is inserted into the narrowed or blocked coronary artery with a catheter and placed in the correct position, then the balloon is inflated and the stent is expanded. After the stent is expanded, the balloon is deflated and removed and the stent is permanently placed to keep the coronary artery open.

✓ Transmyocardial laser revascularization (TMR)

Trans myocardial laser revascularization is a surgical procedure used to relieve severe angina caused by an advanced coronary artery. In this procedure, a small channel is created in the heart muscle using a special CO2 laser, due to which the blood flow in the heart increases. Currently this method is not used.

Define coronary atherosclerosis

Coronary atherosclerosis is a condition of coronary artery disease. In which plaque buildup occurs inside the coronary arteries.

Coronary atherosclerosis involves abnormal lipid and fatty tissue buildup within the coronary arteries. This is known as ‘Atheroma’ and this condition is known as ‘Atherosclerosis’.

This leads to narrowing and thickening of the artery, leading to restriction in blood flow.

Write causes and risk factor of Coronary atherosclerosis

Modifiable Risk Factors:

High cholesterol levels

High blood pressure

smoking

Diabetes

Obesity

Physical inactivity

stress

Unhealthy diet

Non-modifiable risk factors:

Edge

Family history of coronary artery disease

Gender

Race

Write sign and symptoms of coronary atherosclerosis

Chest pain (angina)

Shortness of breath

Fatigue

Arrhythmia

Inadequate cardiac output

diaphoresis

Write diagnostic evaluation of coronary atherosclerosis

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Exercise stress test

Coronary angiography

Coronary calcium scan

Exercise thallium test

PET scan

Write medical management of coronary atherosclerosis

Oxygen therapy: Administering oxygen through a nasal cannula or mask. So that the heart muscles get oxygen.

Vasodilator: Nitroglycerin drug is used as a vasodilator drug. Which dilates blood vessels so that blood flow can be improved.

Antiplatelet: Antiplatelet drugs thin the blood and prevent blood clots. Aspirin for example.

Beta blockers: Provide beta blockers to reduce heart work load. Which slows the heart rate and decreases the blood pressure. For example propanolol, atenolol

Calcium channel blockers: Calcium channel blockers block the entry of calcium into the heart muscle so that the muscle relaxes and helps the arteries to widen and lower blood pressure.

ACE inhibitors: ACE inhibitors prevent the conversion of angiotensin I to angiotensin II and promote diuresis, vasodilation and reduce cardiac workload. For example enalapril, captopril

Statins: Statins decrease cholesterol levels and reduce the risk of plaque buildup in the arteries. For example atorvastatin.

Write surgical management of coronary atherosclerosis

✓ Coronary artery bypass grafting (CABG)

CABG is a type of surgical procedure used to treat coronary artery disease. In which a new route is created or bypassed for a narrowed or blocked coronary artery. In which healthy blood vessels are harvested from any part of the body such as chest, leg, arm and these harvested blood vessels are attached to the coronary artery and the blocked part is bypassed and normal blood flow is restored. CABG is mainly preferred in multiple coronary artery blockage conditions. Also CABG is done when medication and angioplasty fail.

✓ Percutaneous transluminal coronary angioplasty (PTCA)

PTCA is a minimally invasive surgical procedure used to open narrowed and blocked coronary arteries. In which a balloon attached to a catheter is inserted into the narrowing artery, the balloon is then inflated so that the artery widens and the plaque flattens against the artery wall, thereby improving coronary blood flow.

✓ Atherectomy

Atherectomy is a surgical procedure used to remove plaque deposited in an artery. In this procedure, a small cutting device, blade, laser or drill is attached to the catheter and inserted into the artery to cut the plaque and remove the plaque to increase coronary blood flow. Methods like directional, rotational, laser are used in atherectomy.

✓ Coronary stent

A coronary stent is a small mesh-like tube or artificial support device made of metal or polymer. In which the StentMe balloon is inserted into the narrowed or blocked coronary artery with a catheter and placed in the correct position, then the balloon is inflated and the stent is expanded. After the stent is expanded, the balloon is deflated and

Transmyocardial laser revascularization (TMR)

Trans myocardial laser revascularization is a surgical procedure used to relieve severe angina caused by an advanced coronary artery. In this procedure, a small channel is created in the heart muscle using a special CO2 laser, due to which the blood flow in the heart increases. Currently this method is not used.

✓ Endarterectomy: Endarterectomy is a surgical procedure in which plaque inside an artery is removed. This procedure is mainly done to remove a blockage in the carotid artery.

Define myocardial infarction

Myocardial infarction is also known as ‘heart attack’.

Myocardial infarction is a serious medical emergency in which myocardial tissue is permanently damaged and destroyed due to blockage of blood flow to the heart muscle and necrosis.

Write causes and risk factor of myocardial infarction

Causes:

Coronary atherosclerosis

Plaque rupture

Coronary artery spasm

Coronary artery dissection

Embolism

Risk factor:

Risk factors include non-modifiable and modifiable risk factors.

✓ Non-modifiable risk factors:

Non-modifiable risk factors cannot be controlled by ourselves, nor can these risk factors be controlled by exercise, lifestyle modification or medication.

Edge

Gender (males are 3 times more prone to females)

Family history

Race (African Americans have higher incidence of heart disease)

✓ Modifiable risk factors:

Modifiable or controllable risk factors can be controlled by ourselves. Which are as follows :

smoking

High blood pressure

High cholesterol levels

Diabetes

Obesity

Physical inactivity

Unhealthy diet

stress

Type A personality

Lake of Estrogen in Women

Elevated serum hemocysteine

Explain pathophysiology of myocardial infarction

Cholesterol deposits in the wall of the main artery.
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This deposited cholesterol ultimately leads to plaque formation on the artery walls. This is known as atherosclerotic plaque. (The formation of this atherosclerotic plaque takes place over a long period of time i.e. it takes many years to become established.
|
Often this plaque ruptures which activates the blood clotting process. This leads to platelet activation and fibrin deposition leading to thrombus formation in the coronary artery.
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This thrombus completely blocks a coronary artery and restricts blood flow to the myocardium.
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Due to which myocardial cell and tissue are permanently damaged and S

Degree of damage

Zone of Ischemia: In this zone or region, oxygenated blood supply to the heart muscles does not reach and due to this, ischemia is observed. In which no injury or damage is seen in the muscles.

Zone of Injury: In this zone, injuries are seen in the muscles. Muscles are inflamed and damaged. This damage is reversible and can be restored by providing adequate oxygen.

Zone of Necrosis: Due to cut off of oxygen supply in this zone, heart muscle is permanently and irreversible damaged and necrosis is observed.

Write classification of myocardial infarction

✓ Clinical Classification of Different Types of Myocardial Infarction :

Type-1 : Spontaneous myocardial infarction is seen. Which is seen due to ischemia seen due to plaque erosion, rupture, fissuring.

Type – 2 : Myocardial infarction occurs due to secondary ischemia. Which is seen due to imbalance between oxygen demand and supply. This imbalance is seen due to coronary artery spasm, coronary embolism, anemia.

Type – 3 : Myocardial infarction occurs due to sudden unexpected cardiac death. such as cardiac arrest

Type – 4 : Myocardial infarction occurs due to primary percutaneous intervention.

Type – 5 : Myocardial infarction occurs due to cardiac surgery. such as coronary artery bypass surgery

In addition, myocardial infarction is classified based on anatomical structure, diagnostic method and location:

✓ According to the layers of the heart muscles involved:

Transmural infarction:

A transmural infarction involves a major coronary artery with complete occlusion of the artery and an elevated ST segment on the ECG (STEMI).

Subendocardial infarction:

In subendocardial infarction, a small area of ​​the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles is affected and the ST segment is depressed. (NSTEMI)

✓ According to the presence or absence of ST segment elevation :

ST-Segment Elevation Myocardial Infarction (STEMI):

Persistent ST-segment elevation is seen on ECG in this type. which indicates complete occlusion of the coronary artery. Hence immediate reperfusion therapy is required. Like thrombolytic drug, percutaneous coronary intervention.

Non ST-Segment Elevation Myocardial Infarction (NSTEMI):

In this type persistent ST-segment elevation is not seen on ECG but other signs of myocardial injury are present such as elevation in cardiac biomarkers. Invasive procedures are used for the management of NSTEMI. Like coronary angioplasty, revascularization.

✓ According to the location of myocardial infarction:

Left Ventricular Infarction:

In left ventricular infarction, the left ventricle is affected. That is, the blood flow of the left ventricle is blocked.

Right ventricular infarction:

Right ventricular infarction affects the right ventricle in a heart attack.

Write sign and symptoms seen in myocardial infarction

Chest pain or discomfort

Pain may radiate to arm, jaw, neck, shoulder, back

Pain is substernal, severe and diffuse

Filling of heaviness, squeezing

Pain is not relieved by rest and medication

Shortness of breath

Diaphoresis (excessive sweating)

Total, Calm and Moist Skin

Decreases cardiac contractility

Decreases cardiac output

Nausea and vomiting

Restlessness

Dizziness

Lightheadedness

Fanting

Confusion

Disorientation

Fever

Write diagnostic evaluation of myocardial infarction

History Collection

Physical Examination

Electrocardiogram (ST segment elevation)

Echocardiogram

Coronary angiography

Blood test (cardiac biomarker)

Cardiac MRI and CT scan

Stress test

Holter monitoring

Coronary calcium scan

Write medical management of myocardial infarction Myocardial (Write medical management of myocardial infarction)

Oxygen therapy: Administering oxygen through a nasal cannula or mask. So that the heart muscles get oxygen.

Thrombolytic therapy: Use of thrombolytic drugs to dissolve and break down blood clots. E.g. Streptokinase, urokinase

Anticoagulant drug: Use of anticoagulant drug to prevent blood clot formation and thin the blood. E.g. Heparin, warfarin

Vasodilator: Nitroglycerin drug is used as a vasodilator drug. Which dilates blood vessels so that blood flow can be improved.

Antiplatelet: Antiplatelet drugs thin the blood and prevent blood clots. Aspirin for example.

Beta blockers: Provide beta blockers to reduce heart work load. Which slows the heart rate and decreases the blood pressure. For example propanolol, atenolol

Calcium channel blockers: Calcium channel blockers block the entry of calcium into the heart muscle so that the muscle relaxes and helps the arteries to widen and lower blood pressure.

ACE inhibitors: ACE inhibitors prevent the conversion of angiotensin I to angiotensin II and promote diuresis, vasodilation and reduce cardiac workload. For example enalapril, captopril

Statins: Statins decrease cholesterol levels and reduce the risk of plaque buildup in the arteries. For example atorvastatin.

Pain relievers: Opioid drugs are used to relieve pain due to severe pain.

Write surgical management of angina pectoris

Coronary artery bypass grafting

Percutaneous transluminal coronary angioplasty

Coronary stent

Atherectomy

Trans myocardial laser revascularization

Coronary artery bypass grafting (CABG)

CABG is a type of surgical procedure used to treat coronary artery disease. In which a new route is created or bypassed for a narrowed or blocked coronary artery. In which healthy blood vessels are harvested from any part of the body such as chest, leg, arm and these harvested blood vessels are attached to the coronary artery and the blocked part is bypassed and normal blood flow is restored. CABG is mainly preferred in multiple coronary artery blockage conditions. Also CABG is done when medication and angioplasty fail.

Coronary stent

A coronary stent is a small mesh-like tube or artificial support device made of metal or polymer. In which the StentMe balloon is inserted into the narrowed or blocked coronary artery with a catheter and placed in the correct position, then the balloon is inflated and the stent is expanded. After the stent is expanded, the balloon is deflated and removed and the stent is permanently placed to keep the coronary artery open.

Atherectomy

Atherectomy is a surgical procedure used to remove plaque deposited in an artery. In this procedure, a small cutting device, blade, laser or drill is attached to the catheter and inserted into the artery to cut the plaque and remove the plaque to increase coronary blood flow. Methods like directional, rotational, laser are used in atherectomy.

Transmyocardial laser revascularization (TMR)

Trans myocardial laser revascularization is a surgical procedure used to relieve severe angina caused by an advanced coronary artery. In this procedure, a small channel is created in the heart muscle using a special CO2 laser, due to which the blood flow in the heart increases. Currently this method is not used.

Atherectomy

Atherectomy is a surgical procedure used to remove plaque deposited in an artery. In this procedure, a small cutting device, blade, laser or drill is attached to the catheter and inserted into the artery to cut the plaque and remove the plaque to increase coronary blood flow. Methods like directional, rotational, laser are used in atherectomy.

Write nursing management of myocardial infarction

Acute pain related to myocardial ischemia / reduced coronary blood flow as evidenced by facial expressions

Relieve Pain

Conditioning the patient.

To monitor vital signs.

Assessing pain level.

Noting location, duration, intensity, timing etc. of pain.

To assess factors triggering and relieving pain.

Provide Fowler or semi-Fowler position to the patient so that the lungs can expand well.

Providing patient mind diversion therapy. So that the patient’s attention is diverted from the pain.

Providing relaxation therapy to the patient.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain accord and report.

Decrease cardiac output related to decrease cardiac contractility / reduced preload afterload contractility / decrease coronary blood flow as evidenced by increased heart rate

Maintain Cardiac Output / Improve Cardiac Output

Assess the patient’s condition.

To monitor vital signs.

Monitor cardiovascular status.

Monitoring the ECG pattern.

To auscultate heart sound and rhythm.

Assessing the peripheral pulse.

To monitor hemodynamic parameters.

Maintaining intake output chart.

Monitor urine output every hour.

Providing patient with Fowler position or High Fowler position.

Doctor Prescribed I.V. Provide flow.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain record report.

Ineffective cardiac tissue perfusion / impaired tissue perfusion related to reduce coronary blood flow as evidenced by decreased cardiac output, increased heart rate

Promoting Adequate Tissue Perfusion / Improve Cardiac Tissue Perfusion

Assess the patient’s condition.

To monitor vital signs.

Assess the patient’s skin for gross, moist sinuses.

Assessing fluid volume status.

Checking skin temperature, peripheral pulse, capillary refill. With the help of which it can be known whether tissue perfusion is present or not.

Provide bed rest to the patient.

Administer oxygen therapy.

Provide mechanical ventilation if required.

Provide fluid resuscitation.

Administering medicine prescribed by a doctor.

Monitor for side effects and effectiveness of medicine.

To maintain record report.

Impaired gas exchange related to chest surgery / interruption in blood flow to the pulmonary alveoli as evidenced by dyspnea, cynosis

Improve gas exchange

Assess the patient’s condition.

To monitor vital signs.

To monitor respiratory rate, rhythm, arterial blood gas, tidal volume, peak inspiratory pressure, extubation parameters.

Assess skin, mucus membrane, nail bed for sinusitis.

To auscultate breath sounds.

Providing the patient with semi-fowler or fowler position.

Provide bed rest to the patient.

Restrict activity until the patient is hemodynamically stable.

Giving knowledge to the patient about deep breathing exercises.

Provide supplemental oxygen to the patient.

Administer the medicine prescribed by the doctor.

To maintain records and reports.

Anxiety related to disease condition, uncertain prognosis, hospitalization as evidence by verbalization, restlessness, agitation

Reduce Anxiety

Assess the patient’s condition.

Assess for signs of anxiety such as restlessness, sleeplessness.

Paying attention to the psychological needs of the patient and listening carefully to the patient.

Encouraging the patient to express his feelings, discomfort and anxiety.

To solve all doubts and queries of patients.

Providing knowledge to the patient about his condition and treatment so that his anxiety is removed and the patient becomes confident.

Providing psychological support to the patient.

Providing mind diversion therapy and recreational therapy to patients.

Administer an antianxiety agent. Activity intolerance related to fatigue, dyspnea as evidenced by shortness of breath, abnormal heart rate

Inhas Activity Level (Increase Activity Level)

Assess the patient’s condition.

Checking the patient’s activity level.

Provide bed rest to the patient initially.

Then gradually anchor the patient to range of motion exercises.

Assisting the patient with his activities.

2 Provide rest to the patient between activities.

Checking the patient for any breathing difficulty, palpitation during activity.

If present, stop the patient’s activity and provide rest.

Ask the patient to avoid lifting heavy objects.

Asking to avoid activities that strain the heart.

Valvular heart disease

In valvular heart disease, there is an abnormality or dysfunction in the valves in the heart.

Heart only makes blood flow in one direction. For which the valves in the heart are responsible. Because the valve prevents back flow of blood.

These valves keep opening and closing so that the heart can flow blood in one direction.

These valves have a leaflet, a cusp through which the valve closes.

There are mainly two types of valve problems: stenosis and regurgitation

In stenosis the leaflets do not open properly wide i.e. the valve becomes narrowing. Due to which small amount of blood flows through the valve.

In regurgitation, the valves do not close properly, causing small amounts of blood to leak backward. Which is known as insufficiency or incompetence.

Define mitral stenosis

Mitral stenosis is a form of valvular heart disease. In which the opening or orifice of the mitral valve is seen narrowing. which restricts blood flow from the left atrium into the left ventricle. Due to which blood collects in the left atrium.

Write causes of mitral stenosis

Rheumatic fever

Congenital heart defect (affecting the mitral valve)

Infective endocarditis

Autoimmune Disease (SLE)

Age related degeneration

Calcification of mitral valve Write sign and symptoms seen in mitral stenosis (Write sign and symptoms seen in mitral stenosis)

Shortness of breath (after exercise and at night time)

Orthopnea

Fatigue and weakness

Heart palpitation

Irregular heart beat

Chest pain

Swelling in ankles and feet

Cough

Frequent respiratory infections

Loud, rumbling heart murmur Write diagnostic evaluation of mitral stenosis

History Collection

Physical Examination

Echocardiogram

Electrocardiogram

Cardiac catheterization

Chest X Ray

MRI and CT scan Write medical management of mitral stenosis

Diuretics: Use diuretic drugs to reduce pulmonary congestion and fluid overload.

Beta blockers / calcium channel blockers: Use of beta blockers and calcium channel blockers to control heart rate and relieve symptoms such as dyspnea and palpitations.

Anticoagulant: Provide anticoagulant drug to prevent blood clots and thromboembolism as well as to thin the blood.

Antiarrhythmic Medicine: Administer antiarrhythmic medicine to control the rhythm.

Write surgical management of mitral stenosis

Repair of valve

Surgical repair of the valve is also known as ‘commissurotomy’. In which the fused leaflets are separated. Where these leaflets meet are known as commissures. Commissorotomy is performed by two methods.

I) Open Commissorotomy : This method is considered as a traditional method. In which the fused leaflets are directly separated through open heart surgery.

II) Close Commissorotomy : Close commissorotomy method is not used at present. In which the surgeon makes a small incision on the heart and a specially designed device is inserted through it and the through valve is dilated i.e. the leaflet is separated.

Ballon valvuloplasty

Valvuloplasty is also known as ‘percutaneous balloon valvuloplasty’. Valvuloplasty is a minimally invasive procedure used for the management of heart valve disease. In this procedure, a deflated balloon with a catheter tip is inserted through the blood vessels mainly in the groin area and guided to the heart valve where the balloon is placed and inflated. So the narrow or stenosis valve is widened and the opening of the valve is enlarged. So that the blood flow can be improved.

Valve replacement

Valve replacement is a surgical procedure used for the management of severe valvular stenosis. In which the damaged heart valve is surgically removed and replaced with a mechanical or biological (bioprosthetic) valve. Mechanical valves are made from titanium, carbon and other similar materials that do not interact with the body. In addition, lifelong blood thinners are given along with it to prevent blood clots. Whereas biological valves are made from animal tissue (porcine, bovine) such as valve tissue taken from pigs. Biological valve replacements do not provide life-long blood thinners.

Define aortic stenosis

Aortic stenosis is a form of valvular heart disease. In which the opening or orifice of the aortic valve is narrowed which restricts blood flow from the heart to the aorta.

Write causes of aortic stenosis

Calcification of aortic valve

Congenital heart defect

Rheumatic fever

Endocarditis

Degenerative changes

Hypertension

Hypercholesterolemia

Murfan syndrome

Ankylosing spondylitis

Write sign and symptoms seen in aortic stenosis

Chest pain

Fanting, dziness

Fatigue

Shortness of breath (exertion)

Heart palpitation

Irregular heart beat

Rapid pulse

Write diagnostic evaluation of aortic stenosis

History Collection

Physical Examination

Echocardiogram

Electrocardiogram

Cardiac catheterization

Chest X Ray

MRI and CT scan Write medical management of aortic stenosis

Diuretics: Use diuretic drugs to reduce pulmonary congestion and fluid overload.

Beta blockers / calcium channel blockers: Use of beta blockers and calcium channel blockers to control heart rate and relieve symptoms such as dyspnea and palpitations.

Anticoagulant: Provide anticoagulant drug to prevent blood clots and thromboembolism as well as to thin the blood.

Antiarrhythmic Medicine: Administer antiarrhythmic medicine to control the rhythm.

Write surgical management of aortic stenosis

Valvuloplasty

Aortic valve replacement

Transcatheter aortic valve replacement

Ballon valvuloplasty

Valvuloplasty is also known as ‘percutaneous balloon valvuloplasty’. Valvuloplasty is a minimally invasive procedure used for the management of heart valve disease. In this procedure, a deflated balloon with a catheter tip is inserted through the blood vessels mainly in the groin area and guided to the heart valve where the balloon is placed and inflated. So the narrow or stenosis valve is widened and the opening of the valve is enlarged. So that the blood flow can be improved.

Aortic valve replacement

Valve replacement is a surgical procedure used for the management of severe valvular stenosis. In which a large incision is made on the chest, the damaged heart valve is surgically removed and replaced with a mechanical or biological (bioprosthetic) valve. That is, open heart surgery is performed. Mechanical valves are made from titanium, carbon and other similar materials that do not interact with the body. In addition, lifelong blood thinners are given along with it to prevent blood clots. Whereas biological valves are made from animal tissue (porcine, bovine) such as valve tissue taken from pigs. Biological valve replacements do not provide life-long blood thinners.

Transcatheter aortic valve replacement

This is a minimally invasive procedure. In which a catheter is inserted from the femoral artery in the groin area and placed up to the damaged valve. Then with the help of a catheter, a new valve is placed in place of the damaged valve, the new valve is expanded and the leaflet of the old valve is pushed and the function of the damaged valve is performed by this new valve.

Define tricuspid stenosis

Tricuspid stenosis is a valvular condition in which the tricuspid valve becomes narrowing, thereby restricting blood flow from the right atrium to the right ventricle.

Write causes of tricuspid stenosis

Rheumatic heart disease

Congenital heart defect

Carcinoid syndrome

Infective endocarditis

Age Related Changes

Systemic lupus erythematosus

Calcification of valves

Write sign and symptoms seen in tricuspid stenosis

Abdominal swelling (ascites)

Liver enlargement (hepatomegaly)

Jugular vein distension

Ankle edema

Diastolic murmur

Opening snap

Cyanosis

Fatigue

Shortness of breath

Palpitation

Write diagnostic evaluation of tricuspid stenosis

History Collection

Physical Examination

Echocardiogram

Electrocardiogram

Cardiac catheterization

Chest X Ray

MRI and CT scan Write medical management of tricuspid stenosis

Diuretics: Use diuretic drugs to reduce symptoms of fluid overload and right-sided heart failure.

Beta blockers / calcium channel blockers: Use of beta blockers and calcium channel blockers to control heart rate and relieve symptoms such as dyspnea and palpitations.

Anticoagulant: Provide anticoagulant drug to prevent blood clots and thromboembolism as well as to thin the blood.

Antiarrhythmic Medicine: Administer antiarrhythmic medicine to control the rhythm.

Antibiotics: Providing antibiotics drugs to prevent bacterial infections.

Write surgical management of tricuspid stenosis

Repair of valve

Surgical repair of the valve is also known as ‘commissurotomy’. In which the fused leaflets are separated. Where these leaflets meet are known as commissures. Commissorotomy is performed by two methods.

I) Open Commissorotomy : This method is considered as a traditional method. In which the fused leaflets are directly separated through open heart surgery.

II) Close Commissorotomy : Close commissorotomy method is not used at present. In which the surgeon makes a small incision on the heart and a specially designed device is inserted through it and the through valve is dilated i.e. the leaflet is separated.

De vega annuloplasty

Day Vega annuloplasty is a surgical method used to manage tricuspid stenosis and regurgitation. in which the size of the tricuspid annulus is reduced and a ring-like structure is placed in it which provides support to the leaflet of the valve.

Tricuspid valve replacement

Tricuspid valve replacement is a surgical procedure used for the management of severe valvular stenosis. In which a large incision is made on the chest, the damaged heart valve is surgically removed and replaced with a mechanical or biological (bioprosthetic) valve. That is, open heart surgery is performed. Mechanical valves are made from titanium, carbon and other similar materials that do not interact with the body. In addition, lifelong blood thinners are given along with it to prevent blood clots. Whereas biological valves are made from animal tissue (porcine, bovine) such as valve tissue taken from pigs. Biological valve replacements do not provide life-long blood thinners.
Define pulmonary valve stenosis

Pulmonary valve stenosis is a narrowing of the pulmonary valve. which blocks blood flow from the right ventricle to the pulmonary artery.

Write causes of pulmonary valve stenosis

Congenital Heart Disease / Defect (Nunan Syndrome, Tetralogy of Fallot)

Rheumatic fever

Carcinoid syndrome

Endocarditis

Degenerative changes

Write sign and symptoms seen in pulmonary valve stenosis

Heart murmur (first indication)

Exertional dyspnea (shortness of breath)

Fatigue

Chest pain

Palpitation

Syncope

Disneyness

Cyanosis

Right ventricular hypertrophy

Rapid and irregular pulse

Swallowing in leg and abdomen

Hepatomegaly

Write diagnostic evaluation of pulmonary valve stenosis

History Collection

Physical Examination

Echocardiogram

Electrocardiogram

Cardiac catheterization

Chest X Ray

MRI and CT scan Write medical management of pulmonary valve stenosis (Write medical management of pulmonary valve stenosis)

Diuretics: Use diuretic drugs to reduce fluid overload.

Beta blockers / calcium channel blockers: Use of beta blockers and calcium channel blockers to control heart rate and relieve symptoms such as dyspnea and palpitations.

Anticoagulant: Provide anticoagulant drug to prevent blood clots and thromboembolism as well as to thin the blood.

Antiarrhythmic Medicine: Administer antiarrhythmic medicine to control the rhythm.

Prostaglandin E1: Administer prostaglandin E1 in cases where pulmonary valve stenosis is present in the neonate, which maintains ductal patency and adequate pulmonary blood flow.

Antibiotics: Providing antibiotics drugs to prevent bacterial infections.

Write surgical management of pulmonary valve stenosis

Pulmonary valve repair

In pulmonary valve repair, an incision is made on the chest and the pulmonary valve is widened to improve blood flow.

Patch angioplasty

In patch angioplasty, a patch made of synthetic material or the patient’s pericardium is used to widen a narrow section of the pulmonary artery or right ventricular outflow.

Ballon valvuloplasty

Valvuloplasty is also known as ‘percutaneous balloon valvuloplasty’. Valvuloplasty is a minimally invasive procedure used for the management of heart valve disease. In this procedure, a deflated balloon with a catheter tip is inserted through blood vessels mainly in the groin area and guided to the heart valve where the balloon is positioned and inflated. So the narrow or stenosis valve is widened and the opening of the valve is enlarged. So that the blood flow can be improved.

Pulmonary valve replacement

Valve replacement is a surgical procedure used for the management of severe valvular stenosis. In which a large incision is made on the chest, the damaged heart valve is surgically removed and replaced with a mechanical or biological (bioprosthetic) valve. That is, open heart surgery is performed. Mechanical valves are made from titanium, carbon and other similar materials that do not interact with the body. In addition, lifelong blood thinners are given along with it to prevent blood clots. Whereas biological valves are made from animal tissue (porcine, bovine) such as valve tissue taken from pigs. Biological valve replacements do not provide life-long blood thinners.

Inflammation and infections

Define pericarditis

Inflammation of the pericardium is known as pericarditis. Pericardium is the outermost layer of the heart which has a thin sac like membrane structure.

Write classification of pericarditis

Pericarditis is classified based on the composition of the inflammatory exudate as follows:

Pericardial Effusion : In pericardial effusion fluid accumulates in the pericardial sac due to which chest pain, dyspnoea, muffled heart sound are observed.

Constrictive pericarditis: Constrictive pericarditis is characterized by fibrous thickening and calcification of the pericardium due to chronic inflammation. Due to which the heart functions are restricted and due to which the symptoms of heart failure are observed. Write causes of pericarditis

Idiopathic: The exact cause of pericarditis is unknown

Infection: Bacterial viral or fungal infections can cause pericarditis.

Autoimmune Disorders: Autoimmune conditions like rheumatoid arthritis, systemic lupus erythematosus, scleroderma can cause pericarditis.

Trauma: Blunt or penetrating trauma to the chest can cause pericarditis.

Cancer: Cancer metastasizing to the pericardium can cause pericarditis.

Medication: Drug induced pericarditis occurs due to certain medications like penicillin, phenytoin, procainamide.

Radiation therapy: Pericarditis can occur as a side effect of radiation therapy.

Write sign and symptoms seen in pericarditis

Sharp and stabbing chest pain (radiating to left shoulder and neck)

Version when lying down and take deep breath (increase in chest pain during lying down position and deep breathing)

Fever

Cough

Difficulty in breathing (dyspnea)

Weakness and Fatigue

Swelling in leg, feet and abdomen Write diagnostic evaluation of pericarditis (Write diagnostic evaluation of pericarditis)

History Collection

Physical Examination

Laboratory tests (blood cell count, C reactive protein, erythrocyte sedimentation rate)

Electrocardiogram

Echocardiogram

Chest X Ray

Cardiac MRI and CT scan

Pericardiocentesis

Write medical management of pericarditis

Medications and supportive care are used for the management of pericarditis.

Non-steroidal anti-inflammatory drug: Use of non-steroidal anti-inflammatory drug such as ibuprofen, naproxen, aspirin to reduce inflammation and relieve chest pain.

Colchicine: Colchicine is prescribed with NSAIDs to prevent recurrent episodes and reduce inflammation. (Colchicine is an anti-gout agent)

Corticosteroids: Use corticosteroid drugs when NSAID and colchicine medications are contraindicated or ineffective.

Analgesic: Provide analgesic drug to relieve pain.

Antipyretic: Provide antipyretic drug to reduce fever.

Pericardiocentesis: In cases with pericardial effusion and cardiac tamponade, pericardiocentesis is performed to remove excess fluid in the pericardium.

Pericardiectomy: Pericardiectomy is performed in conditions with chronic or recurrent pericarditis. In which part of the pericardium or the entire pericardium is surgically removed. Write nursing management of pericarditis

Hyperthermia related to infection as evidenced by increase body temperature Maintain body temperature

Assess the patient’s condition.

To monitor vital signs.

Monitor temperature every two to four hours.

Maintaining the temperature of the patient’s room.

Provide cold application to the patient.

If the patient feels cold, avoid cold application and provide blanket.

Maintaining adequate hydration.

Ask the patient to intake oral fluids and administer IV fluids.

Administer antipyretic and antibiotic medicine as per doctor’s prescription.

To maintain records and reports.

Anxiety related to disease condition, uncertain prognosis, hospitalization as evidence by verbalization, restlessness, agitation

Reduce Anxiety

Assess the patient’s condition.

Assess for signs of anxiety such as restlessness, sleeplessness.

Paying attention to the psychological needs of the patient and listening carefully to the patient.

Encouraging the patient to express his feelings, discomfort and anxiety.

To solve all doubts and queries of patients.

Providing knowledge to the patient about his condition and treatment so that his anxiety is removed and the patient becomes confident.

Providing psychological support to the patient.

Providing mind diversion therapy and recreational therapy to patients.

Administer an antianxiety agent. Activity intolerance related to fatigue,

Dyspnea as evidenced by shortness of breath, abnormal heart rate

Inhas Activity Level (Increase Activity Level)

Assess the patient’s condition.

Checking the patient’s activity level.

Provide bed rest to the patient initially.

Then gradually anchor the patient to range of motion exercises.

Assisting the patient with his activities.

2 Provide rest to the patient between activities.

Checking the patient for any breathing difficulty, palpitation during activity.

If present, stop the patient’s activity and provide rest.

Ask the patient to avoid lifting heavy objects.

Asking to avoid activities that strain the heart.
Define myocarditis

Infection and inflammation of the myocardium or heart muscles is known as myocarditis. Which is the middle layer of the heart.

Myocardium inflammation causes the heart to become inflamed so that the heart cannot pump properly

. Write causes of myocarditis

Myocarditis is mainly caused by viral infections. It is also caused by bacterial infections, fungal infections, parasite infections and autoimmune disorders and certain medications.

Viral infection: Common viruses like adenovirus, coxsackievirus, influenza, enterovirus, herpes simplex virus can cause myocarditis.

Bacterial infection: Streptococcus, staphylococcus, tuberculosis, gonococcal infection can cause myocarditis.

Fungal infection: Myocarditis can be caused by fungi like Aspergillus, Candida, Histoplasma.

Parasite infection: Myocarditis can be caused by infection with parasites like Trypanosoma cruzi, Toxoplasma.

Autoimmune disorders: Autoimmune disorders such as lupus, rheumatoid arthritis, sarcoidosis, and Wegener’s granulomatosis cause inflammation of the heart muscle.

Certain medications: Myocarditis can occur due to the use of certain medications such as drugs used for the treatment of cancer, immunosuppression.

Toxic Substances: Exposure to toxic substances can also cause myocarditis. Like heavy metals

Write sign & symptoms seen in myocarditis

Myocarditis presents with a variety of signs and symptoms.

Chest pain

Shortness of breath

Arrhythmia

Rapid heart beat

Palpitation

Fatigue

Fever

Head one

Swelling in leg, ankle, feet

Heart failure Write diagnostic evaluation of myocarditis

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Chest x-ray

Cardiac MRI

Endomyocardial biopsy

Blood test (cardiac enzyme, blood culture) Write management of myocarditis (Write management of myocarditis)

✓ Heart failure management: If heart failure is present, use the following medications for its management.

ACE Inhibitor: Use of ACE inhibitor drugs to reduce afterload.

Beta blockers: Provide drugs of the beta blocker group to control heart rate and reduce myocardial oxygen demand.

Diuretics: Using diuretic drugs to manage fluid overload.

✓ Antiarrhythmic drug: Provide antiarrhythmic drug to control arrhythmia.

✓ Immunosuppressive therapy: Provide immunosuppressive drugs to suppress immunity if myocarditis is due to autoimmune disorder.

✓ Antiviral therapy: Administer antiviral drugs to treat myocarditis if it is caused by a viral infection.

✓ Antibiotics therapy: If myocarditis is due to bacterial infection, provide antibiotics drugs to treat it.

Oxygen Therapy: Provide supplemental oxygen if required. Write

nursing management of myocarditis (right nursing management of myocarditis)

✓ Maintain body temperature

Assess the patient’s condition.

To monitor vital signs.

Monitor temperature every two to four hours.

Maintaining the temperature of the patient’s room.

Provide cold application to the patient.

If the patient feels cold, avoid cold application and provide blanket.

Maintaining adequate hydration.

Ask the patient to intake oral fluids and administer IV fluids.

Administer antipyretic and antibiotic medicine as per doctor’s prescription.

To maintain records and reports.

✓ Maintain Cardiac Output / Improve Cardiac Output

Assess the patient’s condition.

To monitor vital signs.

Monitor cardiovascular status.

Monitoring the ECG pattern.

To monitor hemodynamic parameters.

Maintaining intake output chart.

Providing patient with Fowler position or High Fowler position.

Doctor Prescribed I.V. Provide flow.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain record report.

✓ Inhas Activity Level (Increase Activity Level)

Assess the patient’s condition.

Checking the patient’s activity level.

Provide bed rest to the patient initially.

Then gradually anchor the patient to range of motion exercises.

Assisting the patient with his activities.

2 Provide rest to the patient between activities.

Checking the patient for any breathing difficulty, palpitation during activity.

If present, stop the patient’s activity and provide rest.

Ask the patient to avoid lifting heavy objects.

Asking to avoid activities that strain the heart.
Define endocarditis

Infection and inflammation of the endocardium is known as endocarditis. Which is the innermost layer of the heart.

Infection of the inner lining of the heart chambers and heart valves is known as endocarditis.

Which is mainly due to bacterial, viral or fungal infection.

Endocarditis mainly involves heart valve damage. (mainly mitral valve)

Write causes of endocarditis

Bacterial infection (streptococcus, staphylococcus, enterococcus)

Fungal infection (Candida, Aspergillus)

Non bacterial thrombotic endocarditis

Autoimmune Diseases

Trauma and Injury

Dental, urologic or gynecologic surgery, colonoscopy

Immunosuppression

Preexisting heart conditions

Write sign and symptoms of endocarditis

Fever

Chills

Fatigue

Shortness of breath

Chest pain

Night sweats

Heart murmur

Weight loss

Muscle and joint pain

Swelling in fit, leg, abdomen

Specific sign:

Petechiae (small red and purple spots on skin)

Osler’s node (painful raised red or purple subcutaneous lesion in finger and toes)

Janeway lesion: Painless, flat red spot on the palm and sole.

Splinter Haemorrhage: Small, red and brown streak under the nail

Roth spot – roth spot : (Retinal hemorrhage with pale center) Write diagnostic evaluation of endocarditis (Write diagnostic evaluation of endocarditis)

History Collection

Physical Examination

Complete blood count

Blood culture

Inflammatory markers (CRP, ESR)

Serological test

Echocardiography

Electrocardiography

Nuclear medicine test

Cardiac catheterization

Write management of endocarditis

✓ Antibiotics therapy:

Empiric Antibiotics: Provide broad spectrum antibiotics until blood culture report.

Targeted Antibiotics: Administer targeted antibiotics after blood culture report. That is, to administer a specific antibiotic to a specific organism. Continue this course of antibiotics for 4 to 6 weeks.

Staphylococcus aureus : In case of Staphylococcus aureus bacterial infection, give nafcillin or oxacillin along with vancomycin or daptomycin.

Streptococci : Give penicillin or ceftriaxone in case of streptococci bacterial infection. Provide vancomycin in cases with penicillin resistance.

Enterococci: Give ampicillin or vancomycin in combination with gentamicin in case of enterococci bacterial infection.

✓ Surgical Intervention :

Surgical intervention is done in cases of heart failure due to valve dysfunction, uncontrolled infection, abscess formation.

In which mainly valve repair or valve transplantation is done.

Write nursing management of endocarditis

✓ Maintain body temperature

Assess the patient’s condition.

To monitor vital signs.

Monitor temperature every two to four hours.

Maintaining the temperature of the patient’s room.

Provide cold application to the patient.

If the patient feels cold, avoid cold application and provide blanket.

Maintaining adequate hydration.

Ask the patient to intake oral fluids and administer IV fluids.

Administer antipyretic and antibiotic medicine as per doctor’s prescription.

To maintain records and reports.

✓ Maintain Cardiac Output / Improve Cardiac Output

Assess the patient’s condition.

To monitor vital signs.

Monitor cardiovascular status.

Monitoring the ECG pattern.

To monitor hemodynamic parameters.

Maintaining intake output chart.

Providing patient with Fowler position or High Fowler position.

A doctor-prescribed I.V. Provide flow.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain record report.

Inhas Activity Level (Increase Activity Level)

Assess the patient’s condition.

Checking the patient’s activity level.

Provide bed rest to the patient initially.

Then gradually anchor the patient to range of motion exercises.

Assisting the patient with his activities.

2 Provide rest to the patient between activities.

Checking the patient for any breathing difficulty, palpitation during activity.

If present, stop the patient’s activity and provide rest.

Ask the patient to avoid lifting heavy objects.

Asking to avoid activities that strain the heart.
Define rheumatic fever

Rheumatic fever is an inflammatory disorder that occurs as a complication and mismanagement of strep throat infection caused by group A streptococcus bacteria and scarlet fever. Which is mainly seen in children aged 5 to 15 years and is also seen in adults. Which affects the heart, blood vessels, joint, skin and brain.

Rheumatic heart disease is seen as a complication of rheumatic fever.

Write causes of rheumatic fever

Rheumatic fever is caused by group A streptococcus bacteria caused by waterborne strep throat infection and by mismanagement and complications of scarlet fever.

Risk factors for developing rheumatic fever are as follows:

Age : More common in children aged 5-15 years.

Genetic predisposition

Family history

Flooded living conditions

Previous episode of rheumatic fever

The immunosuppressed patient

Write sign & symptoms seen in rheumatic fever

Symptoms of rheumatic fever appear within one to four weeks of getting a strep throat infection.

Some criteria for diagnosing rheumatic fever are given by Duckett Jones. Which is useful for diagnosing rheumatic fever. For example, if two symptoms of the major criteria are present, it can be diagnosed as rheumatic fever, or if one symptom of the major criteria and two symptoms of the minor criteria are present, along with a history of strep throat infection, it can also be diagnosed as rheumatic fever. Major and minor criteria are as follows.

✓ Major Criteria :

For major criteria ‘CASES’ is useful for nanomics.
C : Carditis
A : Arthritis
S : Subcutaneous nodules (Assoph bodies)
E: Erythema marginum (skin race)
S : Sydenham Correa (Rapid Jerky Movement)

Minor Criteria:

For minor criteria ‘FRAPP’ Nanomic is useful.
F : Fever
R : Raised ESR/CRP
A : Arthralgia (joint pain)
P : Prolong PR interval
P : Previous episode of rheumatic fever

Write diagnostic evaluation of rheumatic fever

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Laboratory test

Erythrocyte sedimentation rate

C-reactive protein

ASO titre or antistreptolysin O

Throat swab

Write management of rheumatic fever

Antibiotics Drug: Providing antibiotic drugs to treat infections caused by group A streptococcus bacteria. For example Penicillin, Erythromycin

Anti-inflammatory medication: Provide anti-inflammatory medication to reduce inflammation and relieve pain. Like Ibuprofen, Diclofenac

Corticosteroid: Provide corticosteroid drugs in severe inflammatory conditions. such as prednisolone

Write complication of rheumatic fever

Rheumatic heart disease

Heart failure

Valve stenosis

Valve regurgitation

Arrhythmia

Myocarditis

Joint problem

Write nursing management of rheumatic fever

✓ Maintain body temperature

Assess the patient’s condition.

To monitor vital signs.

Monitor temperature every two to four hours.

Maintaining the temperature of the patient’s room.

Provide cold application to the patient.

If the patient feels cold, avoid cold application and provide blanket.

Maintaining adequate hydration.

Ask the patient to intake oral fluids and administer IV fluids.

Administer antipyretic and antibiotic medicine as per doctor’s prescription.

To maintain records and reports.

✓ Maintain Cardiac Output / Improve Cardiac Output

Assess the patient’s condition.

To monitor vital signs.

Monitor cardiovascular status.

Monitoring the ECG pattern.

To monitor hemodynamic parameters.

Maintaining intake output chart.

Providing patient with Fowler position or High Fowler position.

Doctor Prescribed I.V. Provide flow.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain record report.

✓ Inhas Activity Level (Increase Activity Level)

Assess the patient’s condition.

Checking the patient’s activity level.

Provide bed rest to the patient initially.

Then gradually anchor the patient to range of motion exercises.

Assisting the patient with his activities.

2 Provide rest to the patient between activities.

Checking the patient for any breathing difficulty, palpitation during activity.

If present, stop the patient’s activity and provide rest.

Ask the patient to avoid lifting heavy objects.

Asking to avoid activities that strain the heart.
Define heart block

Heart block is a type of arrhythmia that affects the heart’s electrical system.

In which there is a disruption in the signal that regulates the heart beat. That is, there is a disruption or blockage in the electrical signal that stimulates the contraction of the heart muscles. In short, the electrical system of the heart is disturbed.

Due to which the heartbeat is slow and irregular i.e. the condition of bradycardia is seen.

Classification of heart block (Classification of heart block)

✓ Based on the location of heart block:

Based on the location of blockage of the heart electrical conduction system, heart block is classified as follows:

I) Atrioventricular Block :

Blockages are seen in the atrioventricular node (AV node) and bundle of His in this type. which is the circular junction for the heart conduction system. Atrioventricular block is classified based on its severity as follows:
A) First degree AV block
B) Second degree AV block

C) Third degree AV block

II) Intraventricular Block :

An intraventricular block involves a block in the ventricles of the heart, i.e. a blockage in the electrical signals of the heart’s ventricular muscles. Intraventricular block includes bundle branch block and fascicular block.

Bundle branch block: In this type, there is a blockage in the bundle branch which is responsible for transmitting the signal to a different part of the ventricle.

Fascicular block: In this type, there is a blockage in the fascicles in the bundle branch. Blockage is mainly seen in left anterior fascicle or left posterior fascicle.

✓ Based on the Severity of Heart Block :

Heart block comes in mild to severe forms and is therefore sold in three types depending on its severity:
1) First degree heart block
2) Second degree heart block
3) Third degree heart block

1) First degree heart block: This is the mildest type of heart block in which the electrical system of the heart is slow so that the electrical signal is slow but the conduction system is slow, that is, the electrical signal passes through the AV node to the ventricle. reaches up to First degree heart block is treated with medicine.

2) Second degree heart block: This is a moderate type of heart block in which some electrical signals pass from the atria to the ventricles while some electrical signals fail to reach from the atria to the ventricles. Second degree heart block is further divided into two types:
i) Type 1 second degree heart block
ii) Type 2 second degree heart block

i) Type 1 second degree heart block : Type 1 second degree heart block is known as ‘mobitz type 1’ or ‘wenckebach’s AV block’. This is a less severe form of second degree heart block in which the electrical signal is completely slowed down. Due to being so slow, the heartbeat is skipped by the heart.

ii) Type 2 second degree heart block : Type 2 second degree heart block is known as ‘mobitz type 2’ This is a more severe form of second degree heart block. In which some electrical signals do not reach the ventricle and the heart beat becomes irregular and slow.

3) Third Degree (Complete) Heart Block: Third degree heart block also known as complete heart block is a more severe form of heart block in which there is a complete blockage in the electrical signal passing from the atria to the ventricles, which impairs the heart’s ability to pump. is disturbed. At such times the ventricle generates impulses of its own which is known as functional or ventricular escape beat. A pacemaker is used to treat third degree heart block.

Write causes of heart block

Heart disease (myocardial infarction, cardiomyopathy, congestive heart failure)

Congenital heart defect

Degenerative changes

Medications (beta blockers, calcium channel blockers, antiarrhythmic drugs)

infection

Inflammatory conditions

Electrolyte Imbalance

Autoimmune conditions (lupus)

Write sign and symptoms seen in heart block

Slow heart beat (bradycardia)

Abnormal heart beat

Fatigue

Dizziness or lightheadedness

Fantig

Chest pain

Shortness of breath

Palpitation

Write diagnostic evaluation of heart block

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Holter monitoring

Exercise stress test

An electrophysiologic study

Tilt table test

Blood tests (serum electrolyte levels, cardiac biomarkers)

Event Monitor

Write management of heart block

Management of heart block depends on its type and severity. First degree heart block does not require any treatment. Second degree hard block as well as third degree heart block require the following interventions:

Medication: In some cases, medications such as beta blockers and calcium channel blockers are used to slow the heart rate and improve electrical conduction.

Temporary Pacing: Temporary pacing i.e. temporary pacemaker placement is necessary for symptomatic or severe heart block. In which external pacing i.e. transcutaneous pacing or temporary internal pacing is done. In which a vein through wire is inserted into the heart.

Permanent pacemaker: For persistent heart block, a permanent pacemaker is implanted to regulate the heart rate and provide proper electrical conduction. Permanent pacemaker is the treatment of choice for third degree heart block.

Cardiac resynchronization therapy (CRT): CRT is preferred in cases where heart block is associated with heart failure. In which a special type of pacemaker is implanted which coordinates the contraction of the heart ventricles and improves the pumping function.

Lifestyle Modification: Adopting a healthy lifestyle. Exercising regularly, eating a heart healthy diet, avoiding smoking, managing stress. All these interventions help reduce the risk of complications associated with heart block.

Treatment of underlying causes: Identifying the cause of heart block and treating it.
Complication of heart disease

Define acute heart failure

Acute heart failure is a serious condition in which the heart suddenly becomes unable to pump blood effectively. That is, the heart cannot pump enough blood according to the body’s needs. So immediate treatment is required.

Write causes of acute heart failure

Coronary artery disease

High blood pressure

Cardiomyopathy

Heart valve disorder

Arrhythmia

Infection (myocarditis, endocarditis)

Pulmonary embolism

Thyroid disorder

Drug or alcohol abuse

Write sign & symptoms seen in acute heart failure

Shortness of breath

Rapid or irregular heartbeat

Fluid retention

Pulmonary edema

Swelling in leg, ankle, feet

Coughing and sneezing

Production of Frothy Pink Sputum

Filling of suffocation

Orthopnea

Palpitation

Reduce exercise tolerance

Paroxysmal nocturnal dyspnoea

Decreases urine output

swatting

Fatig

Confusion and Overthinking

Write diagnostic evaluation of acute heart

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Chest X Ray

Brain natriuretic peptide test

Blood tests (serum electrolyte levels, cardiac markers, renal function tests, C-reactive protein)

ABG Analysis

Cardiac Catheterization

Pulmonary artery catheterization

Pulmonary function test

Write management of acute heart failure

Oxygen therapy: Provide oxygen therapy to improve oxygen levels and relieve shortness of breath.

Diuretics: Administer a diuretic drug such as Lasix to reduce fluid buildup and relieve symptoms of congestion.

Vasodilator: Administer vasodilator drugs like nitroglycerin, nitropazide to reduce cardiac workload and improve blood flow.

Ionotropics: Administer ionotropic medicines like dobutamine, milrinone in severe cases in which cardiac output is reduced. Which helps in improving heart function.

Mechanical ventilation: Provide mechanical ventilation to support breathing when conditions such as respiratory distress and respiratory failure are present in severe cases.

Cardiac Resynchronization Therapy (CRT) or Implantable Cardioverter-Defibrillator (ICD): Using CRT and ICD-like devices in selected cases. Which improves heart function and prevents life threatening arrhythmias.

Revascularization: Perform revascularization procedures such as coronary artery bypass graft, percutaneous coronary intervention if acute heart failure is due to heart attack or coronary artery disease.

Restrict Fluid and Sodium: Limit fluid intake and restrict dietary sodium. So that fluid overload can be reduced and symptoms can be prevented from worsening.

Treatment of underlying causes: Identify and treat the underlying causes of acute heart failure. Like heart attack, arrhythmia
Define chronic heart failure (CHF)

Chronic heart failure is known as ‘congestive heart failure’.

It is a chronic progressive condition in which the heart cannot adequately pump blood to meet the body’s needs.

In chronic heart failure, one or more chambers in the heart fail, which means that these chambers are unable to do their work.

Write classification of heart failure

✓ Based on Ejection Fraction :

Heart Failure with Reduced Ejection Fraction (HFrEF):

Heart failure with reduced ejection fraction is also known as ‘systolic heart failure’. In which the ejection fraction is less than 40%. The heart muscles do not contract effectively, reducing the amount of blood pumped out with each beat.

Heart Failure with Preserved Ejection Fraction (HFpEF):

Heart failure with preserved ejection fraction is also known as ‘diastolic heart failure’. In which the ejection fraction is found to be 50% or more. In which the heart muscle contracts properly but does not relax properly. Due to which the heart does not fill up adequately.

Heart Failure with Mid Range Ejection Fraction (HFmrEF):

Ejection fraction in HFmrEF is found to be between 40-49%.

✓ Classification by Functional Status :

A functional classification of heart failure has been done by the New York Heart Association (NYHA). It is classified based on severity of symptoms and limitation of physical activity.

Class (I):

In Class I category, the patient does not experience any symptoms. In this category, the patient is not given any kind of limitation in physical activity. Despite doing ordinary physical activity by the patient, conditions like fatigue, palpitation, shortness of breath are not seen in the patient.

Class (II):

In class II category patients are given slight limitation on physical activity. Like long distance walking. Conditions like fatigue, dyspnea, palpitation are seen due to some ordinary physical activity but no symptoms are seen at rest.

Class (III):

In the Class III category, the patient is given some limitation in physical activity. Such as short distance walking in this category occurs during rest while symptoms occur during physical activity.

Class (IV):

In the Class IV category, limitation of physical activity is given because heart failure symptoms are present even at rest and heart failure symptoms are exacerbated by performing physical activity.

✓ Classification by the side of heart affected :

Left Sided Heart Failure: In left sided heart failure, the left ventricle fails to pump blood effectively into the systemic circulation. This causes fluid to accumulate in the lungs and causes conditions like pulmonary congestion and causes symptoms like dyspnea, orthopnea and paroxysmal nocturnal dyspnea.

Right Sided Heart Failure: In right sided heart failure, the right ventricle fails to effectively pump venous blood into the pulmonary circulation. This results in systemic venous congestion and symptoms such as peripheral oedema, ascites, hepatomegaly and jugular vein distension.

Biventricular Heart Failure: Biventricular heart failure affects both the left and right sides of the heart and presents with a combination of both right-sided heart failure and left-sided heart failure.

✓ Based on the onset and duration:

Acute Heart Failure: Acute heart failure develops suddenly and is life threatening. Which is seen due to heart attack, severe dysrhythmia.

Chronic Heart Failure: Chronic heart failure develops over time and is a long-term condition.

Write causes and risk factors of chronic heart failure

Coronary artery disease

Hyper tension

Valvular heart disease

Cardiomyopathy

Congenital Heart Defect / Disease

Arrhythmia

Myocarditis

Chronic lung disease

Metabolic disorders

Toxic subtensives

Chronic kidney disease

Chronic lung disease

Diabetes

Sleep apnea

Edge

Family history

smoking

Physical inactivity

Write sign and symptoms of chronic heart failure

Signs and symptoms of chronic heart failure are varied. Symptoms seen in chronic heart failure depend on which part of the heart is failing.

✓ Left Sided Heart Failure :

Shortness of breath

Orthopnea

Paroxysmal nocturnal dyspnea

Cough

Pulmonary edema

Crackle & whining sound

Fatigue

weakness

Exercise intolerance

Right Sided Heart Failure:

Peripheral edema

Edema in leg, ankle and feet

Ascites (Fluid Accumulation in Abdomen)

Right upper quadrant abdominal pain

Hepatomegaly (enlarged liver)

Jugular vein distension

Rapid and unexplained weight gain

General Symptoms:

Increased heart rate (tachycardia)

Nozia

Vomiting

Decreases appetite

Confusion

Impaired thinking

Oliguria

Write diagnostic evaluation of the chronic heart failure (Write diagnostic evaluation of chronic heart failure)

History Collection

Physical Examination

Complete blood count

Electrocardiogram

Echocardiogram

Chest X-ray

Cardiac Catheterization

Radionuclide ventriculogram

B Type Natriuretic Peptide (BNP)

N terminal pro BNP

Exercise stress test

Coronary angiography

Cardiac MRI

Pulmonary function test

Write medical management of chronic heart failure (Write medical management of chronic heart failure)

ACE Inhibitors: Providing medicines of the ACE inhibitor group to reduce the workload on the heart. Ex. Enalapril, Lisinopril, Captopril

Angiotensin II receptor blockers: Use of angiotensin II receptor blockers in people who cannot tolerate ACE inhibitors. Ex. Losartan, Vasartan

Beta blockers: Providing drugs of the beta blocker group to reduce heart rate and reduce myocardial oxygen demand. Ex. metoprolol,

Diuretics: Using loop diuretic drugs to manage fluid overload and fluid retention. Ex. Lasix, spironolactone

Vasodilators: Administration of vasodilator group of medicines to dilate the blood vessels and decrease the work load. Ex. Nitroglycerin

Digitalis : Providing medicines of the Digitalis group to improve the cardiac pumping system and improve muscle contraction. Ex. Digoxin

Write surgical management of chronic heart failure

Coronary Artery Bypass Grafting (CABG)

CABG is used to treat heart failure caused by coronary artery disease. In which a new route is created or bypassed for a narrowed or blocked coronary artery. In which healthy blood vessels are harvested from any part of the body such as chest, leg, arm and these harvested blood vessels are attached to the coronary artery and the blocked part is bypassed and normal blood flow is restored.

Heart Valve Repair or Replacement:

If heart failure is due to valvular disease, the affected valve needs to be repaired or replaced.

Left Ventricular Assist Device (LVAD) Implantation:

An LVAD is a type of mechanical pump that assists the left ventricle in pumping blood. This procedure is performed in people who are not eligible for heart transplantation.

Cardiac Resynchronization Therapy (CRT):

CRT is known as another ‘biventricular pacing’. In this procedure, a device is implanted that sends electrical impulses to the left and right ventricles and helps them contract. So that the pumping action of the heart can be improved.

Implantable Cardioverter-Defibrillator (ICD):

Implantable cardioverter-defibrillators are implanted in patients who are at risk of developing life-threatening arrhythmias. The device monitors the heart rhythm and delivers an electrical shock when an arrhythmia is detected to prevent sudden cardiac death.

Heart Transplantation:

Heart transplantation is done when heart failure is in the end stage and no other treatment is effective. In which the patient’s heart is replaced with a donor’s healthy heart.

Surgical Ventricular Reconstruction (SVR):

Surgical ventricular reconstruction involves reshaping the left ventricle and reducing its size. So that the function of the left ventricle can be improved. This procedure is mainly done for heart failure caused by a previous heart attack.

Write nursing management of chronic heart failure

Maintain Cardiac Output / Improve Cardiac Output

Assess the patient’s condition.

To monitor vital signs.

Monitor cardiovascular status.

Monitoring the ECG pattern.

To auscultate heart sound and rhythm.

Assessing the peripheral pulse.

To monitor hemodynamic parameters.

Maintaining intake output chart.

Monitor urine output every hour.

Providing patient with Fowler position or High Fowler position.

Doctor Prescribed I.V. Provide flow.

Administer the medicine prescribed by the doctor.

Assessing for side effects and effectiveness of medicine.

To maintain record report.

Improve gas exchange

Assess the patient’s condition.

To monitor vital signs.

To monitor respiratory rate, rhythm, arterial blood gas, tidal volume, peak inspiratory pressure, extubation parameters.

Assess skin, mucus membrane, nail bed for sinusitis.

To auscultate breath sounds.

Providing the patient with semi-fowler or fowler position.

Provide bed rest to the patient.

Restrict activity until the patient is hemodynamically stable.

Giving knowledge to the patient about deep breathing exercises.

Provide supplemental oxygen to the patient.

Administer the medicine prescribed by the doctor.

To maintain records and reports.

Promoting Adequate Tissue Perfusion / Improve Cardiac Tissue Perfusion

Assess the patient’s condition.

To monitor vital signs.

Assess the patient’s skin for gross, moist sinusitis.

Assessing fluid volume status.

Checking skin temperature, peripheral pulse, capillary refill. With the help of which it can be known whether tissue perfusion is present or not.

Provide bed rest to the patient.

Administer oxygen therapy.

Provide mechanical ventilation if required.

Provide fluid resuscitation.

Administering medicine prescribed by a doctor.

Monitor for side effects and effectiveness of medications.

To maintain record report.

Improve Knowledge Level

Assess the patient’s condition.

Assessing the patient’s knowledge of the disease condition and its treatment.

To provide knowledge to the patient about the disease condition and its prognosis.

Providing knowledge in a language the patient can understand.

To resolve patient’s doubts and queries.
Define pericardial effusion

Pericardial effusion is fluid buildup in the pericardial sac.

Pericardial effusion is excessive fluid accumulation or too much fluid buildup in the pericardial sac surrounding the heart.

The pericardial sac is a double layered sac like structure surrounding the heart.

In more severe cases, pericardial effusion can lead to conditions like cardiac tamponade, which is a medical emergency.

Write causes of pericardial effusion

Infection: Conditions like pericardial effusion are seen due to bacterial, viral, fungal infection in the pericardium.

Inflammatory disorders: Pericardial effusion can also occur due to inflammation in the pericardium.

Trauma: Blunt and penetrating trauma to the pericardium can damage the pericardium and cause fluid to accumulate.

Cancer: A condition like pericardial effusion may arise due to cancer spreading into the pericardium.

Autoimmune disorders: Autoimmune conditions such as systemic lupus erythematosus, rheumatoid arthritis can cause pericardial effusion.

Kidney failure: Pericardial effusion can occur as a complication in kidney failure. Due to this, fluid buildup can occur in the body.

Radiation therapy: Radiation therapy used to treat chest tumors can damage the pericardium and cause pericardial effusion.

Medication: Certain medications like hydralazine, procainamide can cause pericardial effusion.

Write sign & symptoms seen in pericardial effusion

Sharp and stabbing chest pain

Shortness of breath

Fatig

Palpitation

Cough

Anxiety

Restlessness

Hypotension

Swallowing in legs, ankles, abdomen

Write diagnostic evaluation of pericardial effusion

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Chest x-ray

CT scan

MRI

Pericardiocentesis

Blood test

Write management of pericardial effusion

Medication: Provide non-steroidal anti-inflammatory drug and colchicine medicine to reduce inflammation and relieve symptoms. Antibiotic drug should be provided if infection is present.

Pericardiocentesis: Pericardiocentesis is performed in cases with large and symptomatic effusion. In which a needle is inserted into the pericardial sac and the fluid there is drained.

Pericardial Sclerosis: In some cases pericardial sclerosis is used in which a sclerosing agent (talc and doxycycline) is injected into the pericardial sac to promote adhesion between the pericardial layers and prevent fluid accumulation.

Pericardial window: A pericardial window procedure is performed in cases with recurrent effusion and when pericardiocentesis is insufficient to treat it. In which a permanent opening is created in the pericardium. So the fluid there can be drained into the plural space.

Pericardiotomy: In severe cases a pericardiotomy is performed in which the pericardium layer is removed. (The heart can function adequately without the pericardium.)
Define cardiac tamponade

Cardiac tamponade is a complication of pericardial effusion.

Cardiac tamponade is a serious medical condition in which fluid accumulates in the pericardial space causing compression of the heart, affecting the heart’s pumping system.

Due to the pressure on the heart, the ventricles do not fill up properly. Due to which cardiac output decreases and blood pressure drops.

Write pathophysiology of cardiac tamponade

Due to etiological factor
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Fluid accumulates in the pericardium.
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Which creates pressure on the heart.
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Due to which the expanding and filling capacity of the heart is reduced.
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Hence there is a decrease in the stock volume, venous return and also decrease in blood pressure.
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There is a decrease in cardiac output due to which the vital organs of the body do not get enough blood and eventually death.

Write causes of cardiac tamponade

Trauma to the pericardium

Pericarditis

Cancer

Aortic dissection

Myocardial rupture

Iatrogenic causes (cardiac catheterization, pacemaker placement)

Connective tissue disorders (systemic lupus erythematosus, rheumatoid arthritis)

Drug induces (hydralazine, procainamide, minoxidil)

Hypothyroidism

Write sign and symptoms of cardiac tamponade

Beck’s Triad: Beck’s triad consists of the following 3 classic signs: low blood pressure, muffled heart sound, jugular vein distension.

Pulsis paradoxus

Shortness of breath (dyspnea)

Chest pain

Rapid heart beat (tachycardia)

Palpitation

Pulmonary edema

Dizziness

Lightheadedness

Fanting

Wickness

Fatigue

Peripheral edema

Restlessness

Anxiety

Write diagnostic evaluation of cardiac tamponade

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Chest x-ray

CT scan

MRI

Hemodynamic monitoring

Write management of cardiac tamponade

Pericardiocentesis: In pericardiocentesis, a needle is inserted into the pericardial sac and the fluid is drained. So that the pressure on the heart can be reduced.

Pericardial window: When pericardiocentesis fails and is not favorable, a pericardial window is created in which a permanent opening is made on the pericardium so that fluid can drain from there and pressure on the heart can be relieved.

Intravenous Fluid and Medication: Administer intravenous fluid and medication to support cardiac function and blood pressure.

Monitoring: Continuous vital sign, ECG and cardiac output monitor.
Cardiac emergency

Define cardiac arrest

Cardiac arrest is also known as ‘sudden cardiac arrest’.

This is a medical emergency in which the heart suddenly loses its function i.e. the heart beat stops suddenly and unexpectedly.

Cardiac arrest means sudden and unexpected loss of heart function, breathing and consciousness.

Disturbance in electrical system is seen in cardiac arrest while disturbance in blood flow is seen in heart attack.

Cardiac arrest can lead to death if not treated promptly.

Write causes of cardiac arrest

Heart arrhythmia

Coronary artery disease

Cardiomyopathy

Electrolyte imbalance

Structural heart defect

Severe blood loss

Drug overdose

Pulmonary embolism

Hypothermia

Write sign and symptoms of cardiac arrest

Sudden loss of consciousness

Absence of pulse

No breathing

Pale or bluish skin

Dilated pupil

No response to stimuli

Sudden collapse

Write diagnostic evaluation of cardiac arrest

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Coronary angiography

Cardiac MRI

An electrophysiology study

Holter monitoring

Cardiac catheterization

Blood tests (cardiac biomarkers, serum electrolytes)

Write management of cardiac arrest

Cardiac arrest is a medical emergency that requires immediate intervention, the main aim of which is to restore normal circulation and normal heart rhythm. Cardiac arrest can lead to death if not managed promptly.

Recognition and Activation of Emergency Response: Quickly recognize cardiac arrest and activate Emergency Medical Services (EMS).

Early CPR : Perform early cardiopulmonary resuscitation (CPR) until an ambulance, health arrivals and a defibrillator are available. Which immediately helps to restore blood flow.

Early defibrillation: If an automated external defibrillator (AED) is available, use it early. which delivers an electrical shock to the heart and helps restore normal heart rhythm.

Advanced Life Support: EMS providers, paramedics and other trained health care personnel provide advanced life support. Such as administering medicine, establishing an advanced airway, monitoring cardiac rhythm.

Post-resuscitation care: To provide post-resuscitation care after successful full resuscitation. such as optimizing oxygenation and ventilation, maintaining blood pressure and perfusion, treating underlying causes, medication and i.v. Fluid administration, temperature management, hemodynamic monitoring.

Coronary reperfusion: If cardiac arrest is due to a heart attack, use coronary reperfusion therapy such as percutaneous coronary intervention, coronary bypass surgery. Also using corrective heart surgery to treat congenital heart defects.

Heart Transplantation: Heart transplantation in severe congestive heart failure and cardiac arrest.
Define cardiogenic shock

Cardiogenic shock is a serious condition. In which the heart is not able to pump adequate blood according to the body’s needs. Due to which the vital organs of the body do not get enough blood and oxygen supply.

Due to which conditions of hypoperfusion and hypoxia are observed.

Cardiogenic shock is mainly seen as a complication of acute myocardial infarction.

Write causes of cardiogenic shock

Severe heart attack (most common cause)

Myocarditis

Severe heart failure

Dysrhythmia

Pulmonary embolism

Heart valve disorder

Cardiac tamponade

Write sign and symptoms seen in cardiogenic shock

Chest pain

Shortness of breath

Hypotension

Tachycardia

Cold and clammy skin

Altered mental status

Confusion

Weak peripheral pulse

Oliguria

Pulmonary congestion

Cyanosis

swatting

Dizziness

Lightheadedness

Fanting

Write diagnostic evaluation of cardiogenic shock

History Collection

Physical Examination

Electrocardiogram

Echocardiogram

Chest X Ray

Hemodynamic monitoring

ABG Analysis

Laboratory tests (CBC, cardiac biomarkers, serum electrolyte levels, renal function tests)

Write management of cardiogenic shock

Cardiogenic shock is a medical emergency so its treatment is provided by emergency medical care which is as follows:

First provide oxygen therapy to the patient. So that oxygenated blood can reach the vital organs of the body.

Use defibrillation for management of conditions such as serious arrhythmias.

The patient was then given blood transfusion as well as i.v. Administer fluids.

The general management of cardiogenic shock is as follows:

Oxygen Therapy: Providing supplemental oxygen to the patient. So that oxygenated blood can reach the vital organs of the body.

Intravenous Fluid: Administer adequate IV fluid to the patient. Take care that the cardiac load does not increase.

Vasopressor: Use of drugs like norepinephrine, dopamine which increases systemic vascular resistance and also improves blood pressure.

Inotropic agents: Inotropic agents such as dobutamine or milrinone are used. which improves myocardial contractility and cardiac output.

Diuretics: Use loop diuretics to reduce preload in fluid overloaded conditions and relieve pulmonary congestion. For example furosemide

Arrhythmia management: Use of antiarrhythmic medications, electrical cardioversion, and other methods to treat arrhythmias.

Mechanical support devices: Using mechanical support devices such as intra-aortic balloon pumps (IABP) or ventricular assist devices (VADs). Which assists the pumping function of the heart.

Revascularization: Revascularization methods such as percutaneous coronary intervention and coronary artery bypass graft are used to treat myocardial infarction and coronary artery disease.

Hemodynamic Monitoring: Continuous monitoring of vital signs, central venous pressure, pulmonary artery pressure and cardiac output.

ICU Care: Providing close monitoring and intensive care support to patients in specialized units.
Arterial disorder

Define Buerger’s disease

Burger’s disease is also known as ‘thromboangiitis obliterans’. This is a rare condition in which there is inflammation and thrombosis of medium and small-sized arteries in the arm and leg, resulting in reduced blood flow. Burger’s disease is mainly seen in male smokers.

Write causes of Buerger’s disease

The exact cause of Burger’s disease is unknown but appears to be due to a combination of genetic, immunologic, and environmental factors. Following are the predisposing factors for Burger’s disease:

Smoking (Most Significant Risk Factor)

Immune system dysfunction

Genetic predisposition

Vascular endothelial injury

Write sign and symptoms of Buerger’s disease

Persistent pain in arm and leg

Claudication (pain and cramping in muscles of arm and leg)

Coldness, numbness and tingling sensation in hand and fit

Bluish and red color of skin

Development of ulcers and sores

Weak pulse at affected area

Swelling in Hands and Fit

Raynaud’s Phenomenon

Gangrene (in severe cases)

Write diagnostic evaluation of Buerger’s disease

History Collection

Physical Examination

Blood test

Doppler ultrasound

Angiography

Ankle Brachial Index (ABI)

Biopsy

Write management of Buerger’s disease

Smoking Cessation: Stop smoking completely to manage Burger’s disease. Avoiding all forms of tobacco. Don’t be a second hand smoker either.

Vaso Dilator: Use of vaso dilator drugs to dilate the blood vessels. Which improves blood flow.

Antiplatelet agents: Use of antiplatelet agents to prevent blood clot formation.

Thrombolytic drug: Use of thrombolytic drug to dissolve the blood clot.

Iloprost: Iloprost is a prostacyclin analog. which relieves symptoms by dilating blood vessels and inhibiting platelet aggregation.

Pain management: Use analgesics, non-steroidal anti-inflammatory drugs or opioids to relieve pain.

Wound Care: Practice proper wound care to prevent infection and promote healing. Apply adequate dressing by removing dead tissue.

Sympathectomy: In sympathectomy, the nerve that constricts the blood vessels is cut. So that the blood flow can be improved.

Amputation: In severe cases, when the tissue has died, amputation of the affected part is done. So that gangrene and infection can be prevented.

Write prevention of Buerger’s disease

Avoid exposure to extremely cold temperatures.

Avoiding drugs that constrict blood vessels.

Avoiding smoking.

Avoiding prolonged sitting and standing.

Avoid wearing tight and fitting clothes.

Wear cotton socks or wool socks.

Avoid minor surgery on TOS.
Define arterial ulcer

Arterial ulcers are also known as ‘ischemic ulcers’ and ‘arterial insufficiency ulcers’.

Arterial ulcer is a type of arterial disorder in which sores develop on the skin due to inadequate blood supply.

These ulcers mainly develop in the lower extremities. Particularly fit, ankle, lower leg.

Arterial ulcers are associated with peripheral artery disease as well as Burger’s disease. Because the artery is narrowed and blocked due to which blood vessels are restricted and ulcers develop.

Write causes of arterial ulcer

Peripheral Artery Disease (Most Common Cause)

Burger’s Disease

Diabetes Mellitus

Peripheral vascular disease

Atherosclerosis

Atherosclerosis

smoking

Hyperlipidemia

Hyper tension

trauma

Edge

Write sign and symptoms of arterial ulcer

Wound found on lower leg (especially in bony prominence area – ankle, toes, heel)

Ulcers look like a ‘punched out’

Ulcers can appear pale, dry or necrotic

The skin around the ulcer is typically thin, shiny and hairless

Ulcers can penetrate deep into the skin

Wound is yellow, brown, gray and black in color

Ulcers Are Very Painful (Particularly At Night)

Intermittent claudication (cramping pain in leg and buttocks during walking and exercise

Paresthesia

Decrease pulse

Affected limb fails a total

Write diagnostic evaluation of arterial ulcer

History Collection

Physical Examination

Ankle Brachial Index (ABI)

Doppler ultrasound

Toe brachial index

Photoplethysmography

Transcutaneous Oxygen Measurement

Duplex ultrasonography

Magnetic resonance angiography

Computed tomography angiography

Digital subtraction angiography

Write management of arterial ulcer

Medication: Use of antiplatelet agents, statins, to improve blood flow and reduce cardiovascular risk.

Revascularization: Using surgery like angioplasty, stenting, bypass to restore blood flow.

Wound Care: To remove dead tissue and non-viable tissue to prevent the risk of infection and promote healing. Then apply a non-occlusive, moisturizing retentive dressing over it. For this use hydrocolloid, alginate or foam dressing.

Hyperbaric Oxygen Therapy: Using hyperbaric oxygen therapy to promote healing and deliver oxygen to ischemic tissue. In which pressurized oxygen is kept in a room or chamber and breathing is asked.

Negative pressure wound therapy: Negative pressure wound therapy helps remove exudate and increase local blood flow.

Pain Management: Providing analgesic medicine to relieve pain.
Define arterioscelrosis

Arteriosclerosis is also known as ‘hardening of arteries’. In which plaque deposits inside the artery, due to which the artery becomes thick, stiff and hard.

Atherosclerosis is a type of arteriosclerosis.

Write causes and risk factor of arterioscelrosis

High blood pressure

High cholesterol level

smoking

Diabetes

Obesity

Lake of physical activity

Unhealthy diet

Family history of heart disease

Edge

Gender (Men Are More Pron)

Stress Write sign and symptoms of arterioscelrosis (Write sign and symptoms of arteriosclerosis)

Thickening and hardening of arteries

Slow or blocked blood flow at the affected area

Chest pain or discomfort

Shortness of breath

Leg pain or cramping during physical activity (claudication)

Numbness or weakness in extremities

Coldness in limbus Write diagnostic evaluation of arterioscelrosis (Write diagnostic evaluation of arteriosclerosis)

History Collection

Physical Examination

Doppler ultrasound

Angiography

CT scan

MRI

Electrocardiogram

Stress test

Blood Test (Lipid Profile)

Write management of arterioscelrosis

Medication:

Cholesterol-lowering agents: Cholesterol-lowering agents such as statins, fibrates, and PCSK 9 inhibitors help decrease LDL cholesterol levels and reduce the risk of plaque deposits in the arteries.

Blood Pressure Lowering Medications: Blood pressure lowering medications like beta blockers, calcium channel blockers, ACE inhibitors are used to control hypertension and reduce the strain on the arteries.

Antiplatelet drugs: Antiplatelet drugs such as aspirin or clopidogrel prevent the formation of blood clots.

Surgical Procedure:

Coronary stent

A coronary stent is a small mesh-like tube or artificial support device made of metal or polymer. In which the StentMe balloon is inserted into the narrowed or blocked coronary artery with a catheter and placed in the correct position, then the balloon is inflated and the stent is expanded. After the stent is expanded, the balloon is deflated and removed and the stent is permanently placed to keep the coronary artery open.

Coronary artery bypass grafting (CABG)

CABG is a type of surgical procedure used to treat coronary artery disease. In which a new route is created or bypassed for a narrowed or blocked coronary artery. In which healthy blood vessels are harvested from any part of the body such as chest, leg, arm and these harvested blood vessels are attached to the coronary artery and the blocked part is bypassed and normal blood flow is restored. CABG is mainly preferred in multiple coronary artery blockage conditions. Also CABG is done when medication and angioplasty fail.

Endarterectomy:

An endarterectomy is a surgical procedure in which plaque inside an artery is removed. This procedure is mainly done to remove a blockage in the carotid artery.

✓ Life style modification:

Adopt a healthy diet. Like fruit, vegetable, grain, protein.

Avoid a diet high in saturated fat, cholesterol, sodium, sugar.

Doing regular physical activity. Doing physical activity like exercise, walking, running.

Having a smoking session.

Maintaining a healthy weight.
Define aneurysm

An aneurysm is also known as ‘aneurysmal dilatation’.

A localized bulging, ballooning or sac-like structure known as an ‘aneurysm’ is seen at the weak point in the wall of the blood vessels.

Aneurysms occur in all sizes of arteries.

Aneurysms are mainly found in the aorta. Apart from this, it is also found in the arteries supplying blood to the brain, heart, intestines, posterior part of the spleen.

Aneurysm rupture can lead to internal bleeding and stroke-like conditions, which is a fatal condition.

Write classification of aneurysm Aneurysms are classified based on their location, shape and pathology as follows:

Classification by Location :

Cerebral Aneurysm / Intracranial Aneurysm :

An aneurysm found in an artery in the brain is known as a ‘cerebral aneurysm’. Cerebral aneurysms are also known as ‘berry aneurysms’. Because its size is like a small berry. A stroke-like condition is seen due to cerebral aneurysm rupture.

Aortic Aneurysm:

An aneurysm found in the aorta is known as an ‘aortic aneurysm’. Aortic aneurysms are the most common. There are two types of aortic aneurysm:

I) Thoracic aortic aneurysm

II) Abdominal aortic aneurysm

I) Thoracic Aortic Aneurysm : An aneurysm found in the aorta in the thoracic area i.e. chest is known as thoracic aortic aneurysm.

II) Abdominal Aortic Aneurysm : An aneurysm of the aorta located in the abdomen is known as ‘Abdominal Aortic Aneurysm’.

Peripheral Aneurysm:

A peripheral aneurysm occurs in an artery other than the aorta and cerebral artery. such as arteries in the leg and spleen. Peripheral aneurysm mainly popliteal artery, femoral artery, carotid artery.

Classification by Shape:

Saccular Aneurysm:

A saccular aneurysm is a pouching out or sac-like bulging of one side of the artery. Saccular aneurysms are mainly found in cerebral arteries.

Fusiform Aneurysm:

A fusiform aneurysm has a spindle shape dilatation i.e. the entire circumference of the artery is involved. Fusiform aneurysms occur mainly in the aorta and large arteries.

Dissecting Aneurysm:

A tear in the inner layer of the arterial wall causes blood to collect in the layer of the artery and causes the layers of the arterial wall to separate from each other. Dissecting aneurysms are associated with aortic dissection.

Classification by pathology:

True Aneurysm:

In a true aneurysm, all layers of the arterial wall (intima, media, and adventitia) are involved. True aneurysms include saccular and fusiform aneurysms.

False Aneurysm:

A false aneurysm is also known as a pseudo aneurysm. In which blood collects outside the arterial wall but is connected to the surrounding tissue. A false aneurysm is caused by trauma or a surgical procedure.

Write causes and risk factor of aneurysm

Atherosclerosis

High blood pressure

Trauma and Injury

Genetic factor

Congenital defect

Infection of blood vessels

Inflammation

Family history

smoking

Use of Certain Drug – Cocaine

Write sign and symptoms of aneurysm

Signs and symptoms seen in aneurysms depend on the location of the aneurysm.

Cerebral Aneurysm:

Cerebral aneurysms are small and do not cause any symptoms. A ruptured cerebral aneurysm causes the following signs and symptoms:

Sudden and Severe Headache (Worst Headache of One’s Life)

Nausea and vomiting

Steph Neck

Blurred or double vision

Sensitivity to light

Caesar

Loss of Consciousness

Drooping of eyelids

Confusion

Difficulty in speaking

Thoracic Aortic Aneurysm:

Chest pain (typically in back and side)

cuffing

Shortness of breath

Horseness

Difficulty in swallowing

Abdominal Aortic Aneurysm :

Deep constant pain in abdomen or on the side and back of abdomen

Pulsating feeling near the navel
Abdominal aortic aneurysm rupture causes the following symptoms:

Severe pain in abdomen and back

Nozia

Vomiting

Sweaty skin

Rapid heart rate when standing

Internal bleeding

Peripheral Aneurysm:

Pain and swallowing in limb

Pulsating lump in area of ​​aneurysm

Cold fit, toss or finger

General Symptoms:

Sudden and intense pain

Drop in blood pressure

mourning

Loss of Consciousness

Write diagnostic evaluation of aneurysm

History Collection

Physical Examination

X-ray

CT scan

MRI

Angiogram

Ultra sound

Write management of aneurysm

Medication:

Control blood pressure and relax blood vessels

Endovascular repair:

Endovascular repair does not remove the aneurysm but places a stent graft and straightens the artery. In this procedure, a catheter is inserted into blood vessels from the groin area and guided to the site of the aneurysm with the help of imaging techniques and a stent graft is placed there. The wick reinforces the artery wall and diverts blood flow away from the aneurysm to reduce the risk of aneurysm rupture.

Open surgical repair:

Open surgical repair is the traditional and most common surgery used to treat aneurysms. In which an incision is made in the skin and muscle at the site of the aneurysm and the aneurysm is accessed directly. The weak section or portion of the artery is then removed and the remaining end of the artery is stretched with an artificial graft material such as Dacron or Teflon i.e. resection and grafting is done.

Endovascular coiling:

This is a minimally invasive procedure in which a catheter is inserted into the artery and the catheter is advanced to the site of the aneurysm where a coil is placed at the site of the aneurysm to induce clotting and seal the aneurysm.

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Define Raynaud’s disease

Raynaud’s disease is also known as ‘Raynaud’s phenomenon’.

In which the small blood vessels in the fingers and toes are constricted.

These blood vessels are seen constricted due to exposure to cold temperatures or due to stress.

Due to constriction of blood vessels, blood flow is restricted in the affected area.

Types of Raynaud’s disease

Raynaud’s disease is sold in two types as follows:
1) Primary Raynaud
2) Secondary Raynaud

1) Primary Raynaud’s : Primary Raynaud’s is known as ‘Raynaud’s Disease’. This type is seen without any underlying cause. That is, no cause is responsible for the occurrence of Raynaud’s disease.

2) Secondary Raynaud : Secondary Raynaud is also known as ‘Raynaud Phenomenon’. This type is seen due to any underlying cause like autoimmune disorder, connective tissue disorder, use of certain medicine.

Write sign and symptoms of Raynaud’s disease

Episodes range from minutes to hours. These attacks are seen daily or even weekly.

Numbness or tingling sensation in fingers and toes

Burning sensation

Paresthesia

Cold in finger and toss

Color changes in affected finger and toes (in which first the affected area is white in color due to reduced blood flow, then the area becomes blue in color due to reduced oxygen level and lastly the area becomes red in color due to return of blood flow)

Write diagnostic evaluation of Raynaud’s disease

History Collection

Physical Examination

Nailfold capillaroscopy

Cold stimulation test

Blood Test (ESR, Antinuclear Antibody)

Angiography

Doppler ultrasound

Write management of Raynaud’s disease

Life style modification:

Keep Warm : Use gloves, socks, hat and layered dress to maintain body temperature in cold environment.

Avoid Triggers: Cold temperatures, emotional stress to minimize triggers that trigger Raynaud’s disease.

Practice Stress Management Techniques: Practicing relaxation techniques like deep breathing exercises, meditation, yoga, etc. helps to relieve stress.

Limit Caffeine and Nicotine: Avoid consumption of caffeine and nicotine. Because it constricts blood vessels.

✓ Medication:

Vasodilator: A vasodilator drug works directly on the muscles lining the artery walls. It relaxes the muscles there and dilates the arteries. So that the pressure exerted by the blood on the wall of the artery can be reduced. E.g. Nitroglycerin, hydralazine, minoxidil

Calcium channel blockers: CCBs block the entry of calcium into cells/muscles in the heart and blood vessels and help relax the blood vessels. So there is a decrease in blood pressure. E.g. Amlodipine, nifedipine

Alpha blockers: Alpha blockers block alpha adrenergic receptors that relax the smooth muscles in blood vessels. So blood vessels dilate and blood pressure decreases. E.g. Doxazosin, Prazosin

Pentoxifylline : Pentoxifylline is a xanthine derivative that increases blood flow through blood vessels and helps red blood cells pass through constricted blood vessels.

Biofeedback therapy: Biofeedback therapy helps decrease the severity and frequency of episodes. It teaches how to control body temperature and blood flow through relaxation techniques and feedback from temperature sensors.

Avoidance of Vasoconstrictive Substances: Avoiding certain medications and substances such as decongestants, medicines that narrow blood vessels.

Protection from injury: Take necessary precautions to avoid injury to fingers and toes during Raynaud’s disease.
Define hypertension

Hypertension means high blood pressure.

Hypertension is a common condition in which the pressure of the blood against the artery wall is consistently high.

When systolic blood pressure is more than 140 mmHg and diastolic blood pressure is more than 90 mmHg, it is known as hypertension.

In short, hypertension means blood pressure greater than 140/90 mmHg. Write types of hypertension

Hypertension is mainly divided into two types:
1) Primary hypertension
2) Secondary hypertension

1) Primary Hypertension : Primary hypertension is also known as ‘Essential Hypertension’. This is the most common type of hypertension that can develop at any time. The exact cause of primary hypertension is unknown, but hypertension occurs due to certain factors. Such as age, unhealthy diet, lack of physical activity, overweight, obesity, smoking, alcohol consumption, stress, family history, diabetes, metabolic disorders

2) Secondary Hypertension : Secondary hypertension occurs suddenly and due to no underlying condition. Like kidney disease, adrenal gland tumor, thyroid problem (Cussing syndrome), pregnancy, use of oral contraceptive pill,
Write sign and symptoms of hypertension

Hypertension is also known as the ‘silent killer’ as it does not show any noticeable symptoms until it reaches severe levels. However, sometimes people experience the following symptoms:

Head one

Dizziness or lightheadedness

Abnormal heart rhythm

Nose bleed

Shortness of breath

Chest pain

Nausea, vomiting

Blurred or double vision

Buzzing in ear

Confusion

Fatigue

Write diagnostic evaluation of hypertension

History Collection

Physical Examination

Blood test (kidney function test, serum electrolyte level, lipid profile)

Urine analysis

Electrocardiogram

Ambulatory blood pressure monitoring

Echocardiogram

Write management of hypertension

Hypertension is a life long disease so it cannot be cured but it can be controlled.

Lifestyle Modification:

Healthy Diet: Intake of healthy diet like fruits, vegetables, grains, protein. Avoiding unhealthy diet like dairy products, saturated fat, sodium and sugar items,

Regular Exercise: To keep the body healthy and active, do regular exercise so that the weight is also under control.

Weight management: People with overweight and obesity should do weight management. Because obesity is a risk factor for many diseases.

Limit Alcohol: Alcohol Consumption People should keep a limit in alcohol drinking. Avoid drinking alcohol as much as possible.

Avoid smoking: Smoking increases blood pressure and damages blood vessels, so smoking should be stopped.

Stress Management: Use relaxation therapy like deep breathing, meditation, yoga for stress management.

Monitor blood pressure: Have regular blood pressure checks and record the readings.

Medication

Lifestyle changes alone are not enough to control blood pressure. Hence antihypertensive medicine is used to control blood pressure.

Antihypertensive medicines are found in many groups. Hence the choice of medicine depends on the patient’s age, current medical condition, ethnicity and potential side effects.

Beta blockers: Beta blockers block the effect of adrenaline on the heart. Due to which there is a decrease in heart rate and cardiac output and also decrease in blood pressure. E.g. Atenolol, propanolol

Calcium channel blockers (CCBs): CCBs block the entry of calcium into cells/muscles in the heart and blood vessels and help relax the blood vessels. So there is a decrease in blood pressure. E.g. Amlodipine, nifedipine

Alpha blockers: Alpha blockers block alpha adrenergic receptors that relax the smooth muscles in blood vessels. So blood vessels dilate and blood pressure decreases. E.g. Doxazosin, Prazosin

Central alpha agonists: Central alpha agonists decrease the activity of the sympathetic nervous system and decrease heart rate and blood pressure. E.g. Clonidine, methyldopa

ACE inhibitors: ACE inhibitors block the conversion of angiotensin I to angiotensin II, so that blood vessels do not narrow and lower blood pressure. E.g. Enalapril, Lisinopril

Angiotensin II receptor blocker (ARBS2) : ARBS2 blocks the effect of angiotensin II on blood vessels and causes vasodilation. So blood pressure decreases. E.g. Losartan, Olmesartan

Direct renin inhibitors (DRIs): DRIs block the action of renin. which reduces the production of angiotensin II. This angiotensin II constricts blood vessels and raises blood pressure. Hence blood vessels do not constrict due to decreased production of angiotensin II and decrease in blood pressure is observed.

Diuretics: Diuretic drugs help eliminate excess sodium and water from the body and reduce blood volume, thereby lowering blood pressure. E.g. Loop diuretics (furosemide), thiazide diuretics (hydrochlorothiazide)

Vasodilator: A vasodilator drug works directly on the muscles lining the artery walls. It relaxes the muscles there and dilates the arteries. So that the pressure exerted by the blood on the wall of the artery can be reduced. E.g. Nitroglycerin, hydralazine, minoxidil

Write complication of hypertension

Uncontrolled high blood pressure can lead to the following complications:

Heart attack

Heart failure

stroke

Arrhythmia

Aneurysm

Peripheral artery disease

Kidney damage

Eye damage

Metabolic syndrome
Venous disorders

Define deep vein thrombosis – DVT (Define deep vein thrombosis)

Deep vein thrombosis is also known as ‘venous thrombosis’.

In which blood clot (thrombus) formation is seen in one or more deep veins.

Deep vein thrombosis occurs mainly in the leg.

Deep vein thrombosis occurs due to slow blood flow or impaired circulation.

This is a serious condition, if not treated early, the clot travels through the bloodstream and reaches the lungs, causing the life-threatening condition pulmonary embolism.

Write causes and risk factor of deep vein thrombosis

Immobilization

Sitting for long periods

Injury or surgery to vein

Hypercoagulable state

Pregnancy

Old Age

Family history of blood clotting disorders

Cancer

smoking

Obesity

The birth control pill

Hormonal therapy

Write sign and symptoms of deep vein thrombosis

Swelling in affected leg

Pain or tenderness (mainly in the calf.)

Feel like a cramping or soreness

Redness and discoloration of skin

Warmth over the affected area

Swalon Wayne

Leg fatigue or heaviness

Difficulty in walking

Write diagnostic evaluation of deep vein thrombosis (Write diagnostic evaluation of deep vein thrombosis)

History Collection

Physical Examination

Ultrasound

Venography

MRI

Blood test (D-dimer)

Write management of deep vein thrombosis

Anticoagulant therapy: Use of anticoagulant therapy to thin the blood and prevent new clot formation.

Thrombolytic therapy: Using thrombolytic therapy to dissolve the clot and break it down.

Compression therapy: Compression therapy involves the use of elastic compressive stockings that relieve swelling and discomfort and help prevent post-thrombotic syndrome.

Elevation: Elevate the affected limb to heart level. It reduces swelling and improves venous return.

Inferior vena cava filter: An inferior vena cava filter is placed in rare cases when anticoagulant therapy is ineffective or contraindicated. In which the thrombus gets trapped in the filter, preventing the thrombus from reaching the lungs, thereby preventing conditions like pulmonary embolism.

Bypass surgery: A blocked vein in the pelvis and abdomen requires surgery to remove it. For this the doctor bypasses the vein. In addition, angioplasty is often performed.

Write prevention of deep vein thrombosis

The following steps are taken for the prevention of deep vein thrombosis:

Always be active.

Avoiding prolonged immobilization.

Do not stay in sitting position for long time.

Maintaining a healthy weight.

Avoid smoking.

Wearing compression stockings while travelling.
Define venous insufficiency

Venous insufficiency is a venous disorder. In which the vein has difficulty returning blood from the leg to the heart.

In venous insufficiency there is difficulty in the back-up blood flow to the heart in the leg veins.

In venous insufficiency, the valves in the vein are damaged, causing difficulty in the backflow of blood.

Write causes and risk factors of venous insufficiency

Edge

Family history

Obesity

Pregnancy

Sitting and standing for long periods

Tight cloth

Deep vein thrombosis

Varicose vein

smoking

Cancer

Injury to leg

Sedentary life style

Certain medications

Write sign and symptoms of venous insufficiency (Write sign and symptoms of venous insufficiency)

Varicose vein

Leg pain

Swelling in ankle and lower leg

Sensation of heaviness and tiredness

Skin ulcers

Brownies and Reddies Color of Skin.

Pigmentation changes in skin

Itching or burning

The restless leg

Skin around ankle may become thickening and hardening

Write diagnostic evaluation of venous insufficiency

History Collection

Physical Examination

Duplex ultrasound

Venography

Photoplethysmography (PPG)

Venous pressure measurement

CT scan

MRI

Write management of venous insufficiency

Leg Elevation: Elevating the leg to heart level while lying down. Keeping a pillow under the leg while sleeping. So that venous return can be done easily.

Compression therapy: Compression therapy uses elastic stockings that apply pressure to the ankle and lower leg to improve venous blood flow and reduce swelling.

Medication: If venous insufficiency is due to a blood clot, anticoagulant and blood thinner medicines are used for its treatment. Which prevents the formation of blood clot and thins the blood.

Vein ablation: Vein ablation is a minimally invasive procedure that uses heat (radio frequency or laser energy) or chemicals to close varicose veins and incompetent veins. This procedure improves circulation and relieves symptoms like pain, swelling, discomfort.

Sclerotherapy: Sclerotherapy is a common treatment used for venous insufficiency. which is used for small veins. In this procedure, a special solution (sclerosant) is injected directly into the affected vein. So it collapses and fades. Over time it gets absorbed by the body so that symptoms like pain and swelling go away.

Life Style Changes:

Always be active.

Avoiding prolonged immobilization.

Daily walking. Because it improves circulation.

Do not stay in sitting position for long time.

Maintaining a healthy weight.

Avoid smoking.

Wearing compression stockings while travelling.
Define venous ulcer

Venous ulcers are also known as ‘stasis ulcers’.

Due to poor circulation in the leg, sores are seen which are known as venous ulcers.

Venous insufficiency causes open sores in the leg and ankle known as venous ulcers.

This wound heals slowly.

Write causes and risk factor of venous ulcer

Venous insufficiency

Deep vein thrombosis

Varicose vein

Diabetes

Hyper tension

Autoimmune disorders

infection

Lymphedema

smoking

Family history

Pregnancy

Previous leg surgery

Write diagnostic evaluation of Raynaud’s disease

Open wound

Pain in the wound

Swelling at affected leg, ankle, foot

Etching

Reddies and Brownies Color of Skin

Dry and scaly skin

Warm at affected area

Weeping or oozing from a wound

Write diagnostic evaluation of venous ulcer

History Collection

Physical Examination

Duplex ultrasound

Ankle Brachial Index (ABI)

Venography

Blood test

Tissue culture

Biopsy

Write management of venous ulcer

The mainstays of venous ulcer management are to promote wound healing, prevent infection, and treat the cause of venous insufficiency.

Compression therapy: Use elastic stockings as compression therapy. Which applies pressure on the ankle and leg to improve venous blood flow.

Wound care: Proper wound care is essential in the management of venous ulcers. Clean the wound with mild soap and water to remove dead tissue and apply a wet dressing. which promotes wound healing.

Elevation: Elevating the affected leg to heart level improves blood flow and reduces swelling.

Exercise: Doing regular low impact exercises. Like walking, swimming. This exercise helps improve circulation.

Medication: Use non-steroidal anti-inflammatory drugs to relieve pain, reduce inflammation. such as ibuprofen. Using antibiotics drugs to prevent infection.

Treatment of underlying venous insufficiency: Identifying the cause of venous insufficiency and managing it. For which endovenous ablation, sclerotherapy is used.

Life Style Changes:

Always be active.

Avoiding prolonged immobilization.

Daily walking. Because it improves circulation.

Do not stay in sitting position for long time.

Maintaining a healthy weight.

Avoid smoking.

Wearing compression stockings while travelling.
Define varicose vein

In varicose veins, the vein is enlarged, twisted and swollen. Which is mainly seen in blue or dark purple color.

Which is mostly seen in leg and fit area.

Varicose veins are caused by obstructed blood flow.

Write causes and risk factor of varicose vein

Genetic

Edge

Gender (Women are more likely to develop varicose veins)

Pregnancy

Obesity

Prolong standing or sitting

Physical inactivity

Hormonal changes

Constipation Write sign and symptoms of varicose vein

Visible bulging vein

Wayne That Appears Twisted Or Rope Like

Pain in leg (especially after standing or sitting for a long period)

Swelling in leg, fit ankle

Heaviness or stiffness in leg

ETCHING AROUND VEIN

Cramping or muscle spasm in leg

Discoloration of skin

Write diagnostic evaluation of varicose vein

History Collection

Physical Examination

Duplex ultrasound

Venography

CT venography

Write management of varicose vein

Compression therapy: Using elastic stockings for compression therapy. Which applies pressure on the ankle and leg to improve venous blood flow.

Medication: There is no particular medicine to treat varicose veins but medication is used for symptomatic management. For example, anti-inflammatory drugs are used to relieve pain and reduce inflammation.

Minimally Invasive Therapy:

Sclerotherapy: Sclerotherapy involves injecting a solution into the varicose vein to cause the vein to collapse and fade.

Laser therapy: In laser therapy, a strong laser beam is directed at the varicose vein so that the vein fades and disappears.

Endovenous ablation therapy: In endovenous ablation therapy, varicose veins are closed using laser energy or radio frequency.

Electrodesiccation: Electrodesiccation destroys the inner lining of the vessel walls using electric current.

Microphlebectomy: In microphlebectomy, an incision is made and the varicose vein is removed with a hook.

✓ Surgical intervention:

Vein Stripping and Ligation: In this procedure, the affected area of ​​the vein is cut and removed by making a small incision and the end of the vein is tied.

Ambulatory phlebectomy: In ambulatory phlebectomy, small varicose veins are removed by making small punctures in the skin using local anesthesia.

✓ Life Style Modification :

Exercise in a regular manner to improve blood circulation.

Ask the patient to do daily walking.

Do not ask the patient to sit or stand for long periods of time.

Ask the patient to maintain a healthy weight to avoid pressure on the vein.

Asking the patient to elevate the leg to heart level. So that there is ease in venous return and swelling can be reduced.

Ask the patient to avoid smoking.

Write nursing management of varicose vein

Ask the patient to make lifestyle modifications.

Maintain a healthy weight of the patient.

Ask the patient to do regular exercise.

Instruct the patient to consume a high fiber and low salt diet.

Refraining the patient from standing and sitting for long periods of time.

Advise the patient to elevate the leg.

Prohibit the patient from wearing tight clothing.
Define cellulitis

Cellulitis is a common and serious bacterial skin infection.

In which infection is seen in skin and subcutaneous tissue.

Bacteria called Staphylococcus and Streptococci are responsible for causing cellulitis.

Cellulitis is most often seen in the lower leg. Apart from this, it is also seen in the face, arm and other areas.

If cellulitis is not treated, the infection can spread to the blood and lymph nodes and a life-threatening condition occurs.

Write causes and risk factors of cellulitis

Cellulitis is caused by bacteria called Streptococcus and Staphylococcus. In addition, the following factors are responsible for cellulitis:

History of Peripheral Vascular Disease

Cracked or peeling skin

Break in skin or injury to the skin

Weak immune system

Use of corticosteroids

Skin ulcers

Insect bite and sting bite

Write sign & symptoms seen in Cellulitis

Redness and swelling are seen in the affected area.

Infected area feels hot and tender.

Spots and blisters are seen in the infected area.

Swelling is seen in the lymph nodes.

Fever, chills and fatigue are also seen.

Head one

A muscle

Write diagnosis of Cellulitis

History Collection

Physical Examination

Blood count

Culture and sensitivity test

C-reactive protein

Write medical management of Cellulitis

Using systemic antibiotics (penicillin, erythromycin) to treat bacterial infections.

Apply topical medicine on the affected area.

Providing warm moist compression.

Clean the infected area with an antiseptic solution.

Provide analgesic medicine to relieve pain.

Administer antipyretic drug to remove fever.

Write Nursing Management of Cellulitis

Perform vital sign assessments.

Checking the infected area for tenderness and swelling.

Keep the skin dry and clean.

Immobilize and elevate the part with cellulitis.

Changing the patient’s position every two hours.

Clean the infected area with antiseptic solution and then apply topical medicine.

Advising the patient to maintain proper hygiene.

Administering the medicine prescribed by the doctor.

To maintain records and reports.
Lymphatic disorder

Define lymphangitis

Infection and inflammation of the lymphatic vessels is known as ‘Lymphangitis’. Which is a part of lymphatic system. Which is seen as a complication of bacterial infection.

Write causes of lymphangitis

Lymphangitis is mainly caused by bacterial infection. Bacteria called streptococcus and staphylococcus are responsible for causing lymphangitis. In addition, the following causes and risk factors are responsible for developing lymphangitis.

Skin infections (cellulitis, impetigo)

Skin Wound and Injury (Abrasion, Surgical Incision)

Insect bite

Weak immune system

Lymphatic disorders

Chronic use of corticosteroids

Write sign and symptoms of lymphangitis

Red lines or streaks (extending from the site of wound and infection towards the nearby lymph node)

Swelling and inflammation in affected lymphatic vessels

Affected area feels warm and tender

Pain or discomfort in affected area

Fever

Chills

Head one

One of the muscles

Enlarged lymph nodes

Write diagnostic evaluation of lymphangitis

History Collection

Physical Examination

Blood Test (CBC)

Culture and sensitivity test

CT scan

MRI

Ultra sound Write medical management of lymphangitis (Write management of lymphangitis)

Antibiotics: Administering antibiotics drugs to treat bacterial infections.

Pain relievers: Administering analgesic or non-steroidal anti-inflammatory drugs to relieve pain.

Antipyretic drug: Provide antipyretic drug to reduce fever.

Warm compresses: Apply warm moist compresses to reduce inflammation and relieve pain.

Elevating the affected leg.

Surgical intervention in cases where abscess is present.
Define lymphadenitis

Infection and inflammation of the lymph nodes is known as ‘lymphadenitis’.

Write causes of lymphadenitis

Bacterial infection (Staphylococcus aureus, Streptococcus pyogenes, Mycobacterium tuberculosis)

Viral infections (Epstein Barr virus, cytomegalovirus, herpes simplex virus)

Fungal infections (Histoplasma capsulatum, Cryptococcus neoformans, Candida)

Parasitic infections (Toxoplasma gondii, Leishmania species)

Cat Scratch Disease (Bartonella)

Auto immune disorders (SLE, RA)

Cancer (lymphoma, leukemia)

Medication (phenytoin, allopurinol)

Write sign and symptoms of lymphadenitis

Swellon lymphnode

Enlarge and tender lymph node

Pain or tenderness

Redness and warmth

Fever

Ftigh and Malays

Pus or drainage

Write diagnostic evaluation of lymphadenitis

History Collection

Physical Examination

Blood Test (CBC)

Culture and sensitivity test

Ultrasound

CT scan

MRI

Biopsy

Write management of lymphadenitis

Antibiotics:

Administering antibiotics drugs to treat bacterial infections.

Antiviral:

Providing antiviral drugs to treat viral infections.

Antifungal:

Providing antifungal drugs to treat fungal infections.

Pain relievers:

Administering an analgesic or non-steroidal anti-inflammatory drug to relieve pain.

Antipyretic drug:

Provide antipyretic drug to reduce fever.

Warm compresses:

Apply warm moist compression to reduce inflammation and relieve pain.

Elevating the affected leg.

Surgical intervention Incision and drainage in cases where abscess is present.
Define lymphedema

Lymphedema is known as ‘lymphatic obstruction’.

A blockage in the lymphatic system causes fluid to build up in the tissues and causes swelling. This is known as lymphedema.

Swelling is mainly seen in the arm and leg.

Write type of lymphedema There are mainly two types of lymphedema:
1) Primary lymphedema
2) Secondary lymphedema

1) Primary lymphedema : Primary lymphedema occurs due to congenital abnormality or malformation in the lymphatic system. Primary lymphedema is often present at birth or develops during puberty or adulthood. like

Milroy’s disease

Meige’s disease

2) Secondary Lymphedema : Secondary lymphedema is the most common cause of damage to the lymphatic system (lymph node, lymphatic vessels) if

Surgery

Radiation therapy

infection

trauma

Cancer

Obesity

Write sign and symptoms of lymphedema

Swelling in one or more limbs (typically in arm and leg)

Feeling of heaviness and tightness in affected limb

Restricted range of motion in affected limb

Pain and discomfort in affected limb

Thickening or hardening of skin

Presence of pitting edema

Write diagnostic evaluation of lymphedema

History Collection

Physical Examination

Lymphoscintigraphy

Ultra sound

CT scan

MRI

Write management of lymphedema

Compression therapy:

Wearing compression garments and using bandages. It helps reduce swelling and improves lymphatic drainage. Apart from this, compression stockings are also used.

Pneumatic Compression:

In pneumatic compression, a sleeve is worn in the affected arm or leg and connected to a pump that inflates the sleeve intermittently to apply pressure to the arm and leg to move lymph fluid.

Manual Lymphatic Drainage (MLD):

This is a specialized massage technique that helps stimulate lymph flow so that lymph can flow out of the arms and legs and reduce swelling.

Exercise:

Perform gentle exercises to promote lymphatic drainage and improve muscle function.

Complete Decongestive Therapy (CDT):

This is a comprehensive approach that uses a combination of compression therapy, manual lymphatic drainage, exercise and skin care.

Surgical Intervention:

In some cases, surgical interventions such as lymphatic bypass, lymph node transplantation are performed to improve lymphatic drainage.

Skin Care:

Keeping the skin clean and moisturized and protecting it from injury. So that infection can be prevented.
Define elephantiasis

Elephantiasis is also known as ‘lymphatic filariasis’. Which is known as ‘Hatipago’ in our language.

Elephantiasis is a tropical parasitic infection characterized by severe swelling of the skin and underlying tissue and thickening of the skin and gross enlargement of the affected part.

Which mainly affects the limb and genital area.

In elephantiasis, lymph accumulates and swelling occurs due to obstruction in the lymphatic system.

Write causes of elephantiasis Elephantiasis is caused by a parasite (worm) called ‘Wucheria bancrofti’. This parasite is transmitted by the bite of a female mosquito. An infected female mosquito bites the person so that Wucheria bancroftina larvae enter the blood stream and these larvae reproduce and enter the lymphatic system and infect the person causing blockage in the lymphatic system and lymph accumulation and swelling in the affected area. is seen and that area is seen enlarged.

Write sign and symptoms of elephantiasis

Extremely swelling and thickening of skin (main sign)

Swallowing in limb and genital area

Fever

Pain and discomfort

Enlarged lymph nodes

Swallowing in liver and spleen

Write diagnostic evaluation of elephantiasis

History Collection

Physical Examination

Blood test

Ultrasound

Write management of elephantiasis

Medication:

Providing antiparasitic drugs like diethylcarbamazine or albendazole. which kills the parasite. Providing antibiotics drugs to treat secondary bacterial infections.

Hygiene:

Maintaining good hygiene. Perform proper wound care and skin care. Wash the affected area regularly and keep it moisturised.

Compression therapy:

Using compression bandages or garments. which reduces swelling and improves lymphatic drainage.

Exercise and Physical Therapy:

Performing exercises and physical therapy to improve lymphatic flow and reduce swelling.

Surgical intervention:

In severe cases, surgical procedures are performed to remove excess tissue and fluid when other treatments fail.

Reconstructive Surgery:

Perform reconstructive surgery if the male genital area (penis and scortum) is affected.
Define anemia

Anemia is the most common blood disorder characterized by low levels of red blood cells or hemoglobin.

A hemoglobin level less than 12 gm in females and less than 13.5 gm in males can be considered in anemic condition.

Hemoglobin carries oxygen and supplies oxygenated blood to the wall body.

In the condition of anemia, the level of hemoglobin decreases due to which the body is not supplied with enough oxygenated blood and due to which symptoms like fatigue, weakness, shortness of breath are observed.

Write classification of anemia

Anemia is classified based on its morphology, underlying mechanism and etiology as follows:

Based on Morphology:

Microcytic Anemia:

In microcytic anemia, red blood cells are smaller than their normal size i.e. micro. These include iron deficiency anemia and thalassemia.

Normocytic Anemia:

In normocytic anemia, red blood cells are of normal size but their number is low i.e. they are insufficient. It includes aplastic anemia, hemolytic anemia.

Macrocytic Anemia:

In macrocytic anemia, the red blood cells are larger (macro) than their normal size. These include vitamin B12 deficiency anemia, folate deficiency anemia.

Based on underlying mechanism:

Hypoproliferative Anemia:

In hypoproliferative anemia there is decreased production of red blood cells and defective production of red blood cells. Due to which RBC count decreases. These include iron deficiency anemia, vitamin B12 deficiency anemia, folate deficiency anemia, aplastic anemia.

Hemorrhagic Anemia:

Hemorrhagic anemia occurs due to blood loss. In which there is a decrease in RBC count due to blood loss. Which includes acute hemorrhagic anemia and chronic hemorrhagic anemia.

Hemolytic Anemia:

Hemolytic anemia occurs due to increased destruction of red blood cells. In which RBCs are destroyed early. Inherited hemolytic anemia (sickle cell anemia, thalassemia, hereditary spherocytosis) and acquired hemolytic anemia (auto immune hemolytic anemia, drug induced hemolytic anemia, infection-malaria) conditions are seen.

Write types of anemia

Iron deficiency anemia

Vitamin deficiency anemia

Hemolytic anemia

Aplastic anemia

Sickle cell anemia
Define iron deficiency anemia

Iron deficiency anemia is the most common type of anemia. In which there is not enough iron in the body to produce hemoglobin i.e. low level of iron is seen.

Due to which hemoglobin and red blood cells are not formed, hence the level of hemoglobin and red blood cells is low and the condition of anemia is seen.

Iron is very important for the synthesis of hemoglobin. It is also essential for oxygen carrying. Because oxygen binds with iron in hemoglobin. Write causes of iron deficiency anemia

Iron deficiency anemia occurs due to inadequate iron supply. The following causes are responsible for iron deficiency anemia:

Inadequate dietary intake (less intake of iron rich food)

Chronic blood loss

Malabsorption

Increase iron requirement

Chronic Disease (Chronic Kidney Disease, Chronic Heart Failure)

Genetic disorder (hemochromatosis)

Write sign and symptoms of iron deficiency anemia

Iron deficiency anemia has symptoms similar to those seen in normal anemia:

Decreases hemoglobin level

Decreases serum iron level

Fatigue

Wickness

Pale skin color

Shortness of breath

Headache and Dizziness

Cold hand and fit

Brittle nail

Paika

Soreness or swallowing of tongue

Restless Leg Syndrome

Increase heart rate

Write diagnostic evaluation of iron deficiency anemia

History Collection

Physical Examination

Complete blood count

Serum Iron Study (Serum Iron Level, Total Iron Binding Capacity (TIBC)

Serum ferritin test

Fecal occult blood test

Fecal immunochemical test

Serum transferrin

Peripheral blood smear

Write management of iron deficiency anemia

Identify and treat underlying causes: Identify and treat underlying causes of iron deficiency anemia.

Iron supplementation: Oral iron supplementation is the first line treatment for iron deficiency anemia. Ferrous sulfate, ferrous gluconate, and ferrous fumarate are commonly prescribed oral forms of iron. Iron supplementation is taken on an empty stomach or with vitamin C. This increases the absorption of iron. Milk and antacids are avoided with iron supplementation. Because it interferes with the absorption of iron.

Intravenous iron therapy: Intravenous iron therapy is given when oral iron supplementation is ineffective (such as malabsorption). In which iron is delivered directly into the bloodstream.

Dietary modification: Ask the patient to consume iron rich food. Like red meat, fish, egg beans, poultry, lentils, tofu, spinach

Blood Transfusion: Blood transfusion is done in cases where iron deficiency anemia is due to blood loss.
Define pernicious anemia

Pernicious anemia is known as ‘additional anaemia’.

Pernicious anemia is a type of vitamin B12 deficiency anemia. In which the body fails to absorb vitamin B12 from the gastrointestinal tract.

Vitamin B12 is essential for proper development of RBC. Hence, due to deficiency of vitamin B12, RBCs do not develop properly and this leads to a decrease in the number of RBCs and an anemic condition. Write causes of pernicious anemia

Pernicious anemia is primarily caused by the body’s inability to absorb vitamin B12.

Which is mainly seen due to deficiency of intrinsic factor produced by stomach.

This intrinsic factor is essential for the absorption of vitamin B12 in the small intestine.

The causes of pernicious anemia are as follows:

Autoimmune gastritis

Genetic factor

Family history

Gastrointestinal Diseases and Surgery (Crohn’s Disease, Celiac Disease)

Poor intake of vitamin B12 rich diet

Autoimmune disorders (autoimmune thyroid disease, Addison’s disease, Graves’ disease, myasthenia gravis, type 1 diabetes)

Write sign and symptoms of pernicious anemia

Fatigue

Wickness

Pale skin color

Cold and clammy skin

Shortness of breath

Palpitation

Glossitis

Loss of appetite

Weight loss

Diarrhea

Paresthesia

Gait abnormality

Muscle weakness

Mood changes

Confusion

Memory loss

Depression

Ataxia

Jaundice

Brittle nail

Angular cheilitis

Write diagnostic evaluation of pernicious anemia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Serum vitamin B12 levels

Serum Methylmalonic Acid (MMA)

Homocysteine ​​level

Intrinsic factor antibody

Parietal cell antibodies (PCA)

Gastrin levels

The Schilling Test

Bonemarrow Examination

Write management of pernicious anemia

Vitamin B12 Replacement Therapy:

Vitamin B12 Injection: To correct vitamin B12 deficiency by giving an injection of vitamin B12. Administer intramuscular injections of 1000 micrograms daily for one to two weeks initially. Then every month to give injections of vitamin B12. Oral Supplement:

High-dose vitamin B12 tablets are given in people for whom injections of vitamin B12 are not preferred. In which 1000-2000 microgram tablets are preferred for daily use.

Nasal spray: A nasal spray is often prescribed along with the injection.

Dietary Intake: Ask the patient to consume a vitamin B12 rich diet. Like meat, liver, green leafy vegetables, citrus foods, berries

Treat Underlying Conditions: Identify and treat the cause of pernicious anemia.

Define hemolytic anemia

Hemolytic anemia is a type of anemia in which red blood cells are destroyed early in their life span, resulting in a shortage of RBCs.

• Write types of hemolytic anemia (Write to type of hemolytic anemia)

1) Intrinsic (Inherited) Hemolytic Anemia: In Inherited Hemolytic Anemia, there is an inherited defect in the red blood cell i.e. there is a defect in the gene controlling the production of RBC and due to this defective gene, the RBC breaks down early and the condition of anemia is observed. Inherited hemolytic anemia includes the following causes.

Hereditary spherocytosis: In spherocytosis, there is a defect in the membrane protein in red blood cells due to which the RBCs are ball-shaped and destroyed early.

Hereditary elliptocytosis: In elliptocytosis, cell membrane problems are seen. Its RBCs are elliptical i.e. oval in shape and the life span of these RBCs is short.

G6PD Deficiency (Glucose 6 Phosphate Dehydrogenase Deficiency): G6PD deficiency is characterized by deficiency of the enzyme glucose 6 phosphate dehydrogenase in RBCs. Due to the deficiency of this enzyme, red blood cells are damaged and die in contact with any substance.

Pyruvate Kinase Deficiency: This is a metabolic defect characterized by a deficiency of the enzyme pyruvate kinase. Due to which the production of ATP in the red blood cell decreases due to which the RBC breaks down easily.

Sickle cell disease: In sickle cell disease, there is a mutation in the hemoglobin gene that leads to the production of abnormal hemoglobin (HBs) and due to this the RBCs are sickle shaped and the RBCs die early.

Thalassemia: Thalassemia is an inherited blood disorder. In which the globin chain needed to form hemoglobin is absent, resulting in reduced production of hemoglobin and hence reduced levels of RBCs.

2) Extrinsic (acquired) hemolytic anemia: In extrinsic hemolytic anemia, due to external factors (other than genetic factors), the red blood cells are destroyed early and the condition of anemia is observed. Extrinsic hemolytic anemia is seen due to the following reasons.

Autoimmune hemolytic anemia: In autoimmune hemolytic anemia, antibodies are produced by the immune system that attack the red blood cells and the red blood cells are destroyed.

Alloimmune Hemolytic Anemia: In alloimmune hemolytic anemia, red blood cells are attacked by another person’s antibodies, such as a reaction to a blood transfusion.

Drug Induced Hemolytic Anemia: Hemolysis can occur due to certain medicines. In which the immune system is triggered by this medicine due to which it attacks the red blood cells or this is also seen due to direct toxicity.

Microangiopathic Hemolytic Anemia (MAHA): In MAHA, red blood cells undergo mechanical destruction as they pass through damaged small blood vessels and a reduction in red blood cells is observed. Microangiopathic hemolytic anemia is seen in conditions like thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, disseminated intravascular coagulation.

Infection: Certain infections such as malaria, Clostridium perfringens cause conditions of hemolysis.

Mechanical Destruction: Destruction of RBCs occurs due to physical factors such as artificial heart valves, extracorporeal circulation (hemodialysis).

Write sign and symptoms of hemolytic anemia

Fatigue and weakness

Paler skin

Shortness of breath

Rapid heart beat

Head one

Cold skin

Jaundice

Dark urine

Splenomegaly

Goal stone

Abdominal pain

Leg ulcer

Write diagnostic evaluation of hemolytic anemia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Reticulocytes count

Hemoglobin electrophoresis

Direct immunoglobulin test / Coombs test

Indirect immunoglobulin test

Hepatoglobin, bilirubin and liver function test

G6PD Assay (Glucose 6 Phosphate Dehydrogenase)

Osmotic fragility test

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Bone marrow aspirate and biopsy

Write management of hemolytic anemia

Blood transfusion: Blood transfusion is done in patients with severe hemolytic anemia. In which intravenous blood is administered to the patient.

Iron and folic acid supplementation: Provide iron and folic acid supplementation to the patient. Which supports erythropoiesis and helps in the production of red blood cells.

Erythropoiesis stimulating agent: In some chronic cases an erythropoiesis stimulating agent is provided which stimulates the production of red blood cells.

Splenectomy: In splenomegaly and damaged spleen, splenectomy is performed i.e. removal of the spleen.

Bone marrow transplantation: Damaged stem cells or bone marrow are replaced with healthy stem cells or bone marrow.

~ Management as follows in cases with autoimmune hemolytic anemia

Steroids: Steroids are the first line treatment for the management of autoimmune hemolytic anemia. such as prednisolone.

Immunosuppressant: An immunosuppressant drug such as rituximab is used when corticosteroids are ineffective.

Plasmapheresis: Plasmapheresis is used to remove excess antibodies from the blood. In this procedure blood is removed from the body and the plasma is separated from the blood and the plasma is replaced and the blood is re-entered into the body.

Treat Underline Causes: Identify and treat causes of hemolytic anemia.
Define aplastic anemia

Aplastic anemia is a rare but serious condition characterized by deficiency of all types of blood cells ie low levels of red blood cells, white blood cells and platelets.

In aplastic anemia, the bone marrow fails to produce adequate amounts of cells. Because the stem sac of the bone marrow is damaged.

Write causes of aplastic anemia

Idiopathic

Autoimmune disorders

Exposure to toxins (pesticides, benzene, certain medications)

Viral infection (hepatitis, cytomegalovirus, Epstein Barr virus, HIV)

Inherited disorders (conditions like Fanconi anemia, dyskeratosis conjunctiva, Diamond Blackfan anemia cause stem cell damage and aplastic anemia)

Radiation and Chemotherapy

Pregnancy

Write sign and symptoms of aplastic anemia

Low levels of red blood cells, white blood cells and platelets

Fatigue

Wickness

Shortness of breath

Pale skin color

Frequent infections

Easy Bruising and Building

Petechiae (small red and purple spots)

Nose bleed, gum bleed

Rapid or irregular heart beat (tachycardia)

Head one

Dizziness

Lightheadedness

Enlarged spleen

Write diagnostic evaluation of aplastic anemia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Bone marrow aspiration

Bone marrow biopsy

Cytogenetic testing

Immunological study

x ray

CT scan

Blood Transfusion: Blood transfusion and platelet transfusion to correct anemia. Complications like iron overload can occur due to repeated blood transfusions.

Bone marrow or stem cell transplantation: Bone marrow transplantation or stem cell transplantation in young patients with severe aplastic anemia. In which dysfunctional bone marrow or damaged stem cells are replaced with healthy donor cells, normal cell production can be restored.

Immunosuppressive therapy: People with moderate to severe aplastic anemia are given immunosuppressive therapy. which suppresses immunity so that the immune system can suppress the attack on bone marrow. Cyclosporine, anti thymocyte globulin is used as immunosuppressive therapy.

Bone marrow stimulating medicine: Providing hormonal supplements to stimulate the bone marrow. such as erythropoietin, colony stimulating factor

Antibiotics: Administering antibiotic drugs to treat and prevent infection.
Define sickle cell anemia

Sickle cell anemia is also known as ‘sickle cell disease’.

Sickle cell anemia is an inherited blood disorder. In which red blood cells are seen in sickle shape i.e. they are seen in sickle or crescent shape.

These sickle-shaped red blood cells stick to the blood vessels and block the blood vessels.

Abnormal hemoglobin production is seen in sickle cell anemia. Which is known as hemoglobin S.

These hemoglobins stick together and form clumps after delivering oxygen to body tissues.

Due to this clot, the red blood cell becomes stiff and its shape looks like a sickle, and the red blood cells of this sickle shape get stuck in the blood vessels and block the blood vessels.

Write causes of sickle cell anemia

Sickle cell anemia is an inherited disorder. Hence, the condition of sickle cell anemia occurs when one copy of the sickle cell gene is inherited from both the parents.

If a person has only one copy of the sickle cell gene present, they do not have the condition of sickle cell anemia. But such people pass the sickle cell gene to their children.

Thus, for sickle cell anemia, one copy of the sickle cell gene must be inherited from both parents.

If both parents have one normal gene and one abnormal gene, their children have a 25% chance of inheriting both normal genes, a 50% chance of inheriting one normal and one abnormal gene, and a 25% chance of inheriting both abnormal genes.

Write sign and symptoms of sickle cell anemia

Chronic Anemia: Sickle-shaped red blood cells break down rapidly, resulting in an anemic condition. Due to which fatigue, weakness is seen.

Episodes of pain: Frequent episodes of pain are known as ‘sickle cell crises’. Sickle red blood cells cause blockages in blood flow, causing severe pain. These crises are mainly seen in the chest, abdomen and joints.

Swelling of hand and foot (dactylitis): Painful swelling is seen in hand and foot. Which is the first sign seen in infants and young children.

Delayed growth and development: Growth and development delays are seen in children with sickle cell anemia.

Jaundice: Due to the increased breakdown of red blood cells, the level of bilirubin in the body increases due to which the skin, sclera, mucus membrane appear yellow in color.

Vision problem: Blood vessels in the eye get damaged due to which vision issue is seen.

Acute chest syndrome: Acute chest syndrome is seen in the condition of sickle cell anemia. In which conditions like chest pain, breathing difficulty, fever, visible lung infiltrate are seen.

Stroke: A condition of stroke occurs due to blockage of blood flow in the brain.

Priapism: Painful prolonged erection is seen.

Leg Ulcers: Chronic, non-healing sores occur on the leg.

Organ Damage: Due to frequent blood flow blockage, organs like spleen, liver, kidney and heart are damaged.

Write diagnostic evaluation of sickle cell anemia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Hemoglobin electrophoresis

Reticulocytes

Bilirubin level

Serum iron level

Genetic testing

Write management of sickle cell anemia

Hydroxyurea: Hydroxyurea stimulates the production of fetal hemoglobin and helps reduce the frequency of pain episodes and acute chest syndrome.

Pain management: Use non-steroidal anti-inflammatory drugs and opioid drugs to control pain episodes.

Blood Transfusion: Blood transfusion in conditions with severe anemia, acute chest syndrome and stroke.

Bone Marrow Transplantation: Bone marrow transplantation is performed to potentially cure sickle cell anemia. In which the faulty bone marrow is replaced with bone marrow from a healthy donor.

Antibiotics: Give penicillin prophylactically to prevent infection in a child with sickle cell anemia. Because infections caused by Streptococcus pneumoniae bacteria are seen in such children.
Define thalassemia

Thalassemia is an inherited blood disorder, also known as inherited ‘haemolytic anaemia’. In which there is a decrease in the synthesis of hemoglobin

This mainly involves a defect or abnormality in the messenger RNA (mRNA) that synthesizes the polypeptide chain of hemoglobin.

Different types of thalassemia have defects in different polypeptide chains. Which includes alpha beta and gamma chain.

A defect in this polypeptide chain leads to insufficient synthesis of hemoglobin, known as thalassemia.

A condition of hypochromic microcytic anemia is seen due to the formation of defective hemoglobin in RBCs.

1) Alpha Thalassemia
2) Beta thalassemia

1) Alpha Thalassemia :

In alpha thalassemia there is a missing or mutated alpha globin gene in the alpha chain of hemoglobin and this causes the condition of thalassemia.

I) Silent carrier : In this one alpha globin gene is missing or mutated and very mild anemia is observed and no symptoms are observed.

II) Alpha Thalassemia Trait (Minor): In this type, two alpha globin genes are missing or mutated and this results in a condition of mild anemia and mild symptoms such as fatigue or pale skin.

III) Hemoglobin H Disease: In this three alpha globin genes are missing and mutated. This leads to moderate to severe anemic conditions and other complications (bone deformity, splenomegaly).

IV) Alpha thalassemia major (hydrops fatalis): In this type all i.e. all four alpha globin genes are missing and severely mutated. Due to this condition of severe anemia is seen and death happens soon after birth.

2) Beta thalassemia : In beta thalassemia there is a missing mutated beta globin gene in the beta chain of hemoglobin. Beta thalassemia is divided into following types:

I) Beta thalassemia minor
II) Beta thalassemia intermedia
III) Beta thalassemia major

I) Beta Thalassemia Minor (Trait): Thalassemia minor, also known as thalassemia trait, is the mildest form of thalassemia. Thalassemia minor occurs when only one mutated beta globin gene is inherited from a parent. A child with thalassemia minor usually has no symptoms. He or she has symptoms of mild anemia. People with thalassemia minor usually have hemoglobin levels slightly below normal, but they usually do not require treatment. People with this thalassemia minor behave as carriers, meaning their children inherit the mutated beta globin gene.

II) Beta Thalassemia Intermedia : Thalassemia intermedia is an intermediate form of thalassemia which is less severe than thalassemia major but more severe than thalassemia minor. A child with thalassemia intermedia has two mutated beta globin genes, but the degree of severity varies. Symptoms range from mild to moderate anemia. Some children also require blood transfusions to manage symptoms. The need for treatment varies according to the severity of symptoms in a child with thalassemia intermedia. Complications like bone deformity, splenomegaly and gall stones are seen in children with thalassemia intermedia. But these are usually less gray compared to thalassemia major.

III) Beta Thalassemia Major (Cullis Anemia): Thalassemia major is the most severe form of thalassemia. Thalassemia major occurs when two mutated beta globin genes are inherited. One of both parents. This results in a significant reduction or absence of the beta globin chain, a condition of severe anemia. Hence blood transfusion is required for the child to survive. Conditions like growth retardation, skeletal deformity, hepatosplenomegaly are seen in children with thalassemia major.

Explain the sign and symptoms of the thalassemia

The signs and symptoms seen in thalassemia depend on the type and severity of thalassemia.

✓ Mild Thalassemia :

Mild anemia

Fatigue or weakness

Asymptomatic

✓ Moderate to severe thalassemia:

Fatigue and weakness

Shortness of breath

Pale or yellow skin (jaundice)

Facial bone deformity

Slow growth and delayed puberty

Dark urine

Abdominal swallowing (due to splenomegaly, hepatomegaly)

Goal stone

Heart palpitation

Heart problem (due to overload of iron)

Explain the diagnostic evaluation of the thalassemia

History Collection

Physical Examination

Complete blood count test

Hemoglobin electrophoresis

High Performance Liquid Chromatography

Peripheral blood smear

Reticulocytes count

Mean Corpuscular Volume (MCV)

Mean Corpuscular Hemoglobin (MCH)

Iron studies (serum iron and ferritin, total iron binding capacity

Genetic Testing (DNA Analysis)

Bone marrow examination

Additional Test:

Liver function test

Serum bilirubin test

Bone Marrow Studies

Ultrasound

MRI

Explain management of the thalassemia.

Regular Blood Transfusion: Patients with severe thalassemia (particularly beta major thalassemia) require regular blood transfusion, so regular blood transfusion is done in such patients to maintain the hemoglobin level.

Iron chelation therapy: Frequent blood transfusions can cause iron overload and cause organ damage. Iron chelation therapy is used to prevent iron overload. Which helps to remove excess arsenic from the body. Such as deferoxamine, deferiprone, deferasirox.

Folic Acid Supplements: Folic acid is essential for red blood cell production so provide folic acid supplementation to the patient. So the production of RBCs can be increased.

Splenectomy: In some cases with splenomegaly, red blood cell distribution is high, so splenectomy is done in such cases.

Bone marrow or stem cell transplantation: This is an option to potentially cure thalassemia. In which the patient’s bone marrow is replaced with the bone marrow of a healthy donor person.

Gene therapy: Experiments are underway to develop gene therapy to correct the genetic defect of thalassemia. The purpose of which is to create a functional copy of the affected gene and replace it in the body in place of the affected gene.

Hydroxyurea: This medication stimulates the production of fetal hemoglobin. which compensates for defective adart hemoglobin.
Define polycythemia

Polycythemia is also known as ‘erythrocytosis’.

Polycythemia means increased levels of red blood cells in the blood.

Hemoglobin and hematocrit levels are also higher due to increase in red blood cells.

In which hemoglobin level is more than 16.5 gm in female and hemoglobin level is more than 18.5 gm in male.

Also, hematocrit level is more than 48% in females and hematocrit level is more than 52% in males.

Due to the increase in the level of red blood cells in the blood, the blood becomes thicker due to which conditions like blood clot, heart attack, stroke are seen.

Write causes and risks factor of polycythemia

Genetic factor

Family history

Chronic hypoxia

Erythropoietin producing tumors

Kidney disease

Chronic lung disease

High Altitude

smoking

Use of Certain Medications (Anabolic Steroids)

Write types of polycythemia

There are mainly two types of polycythemia which are as follows:

1) Primary Polycythemia : Primary polycythemia is also known as ‘polycythemia vera’. This is a rare blood disorder in which a mutation in the JAK2 gene causes the bone marrow to produce large amounts of RBCs, leading to increased levels of RBCs in the blood. This is a type of myeloproliferative disorder associated with abnormal growth of cells in the bone marrow.

2) Secondary Polycythemia: Secondary polycythemia is the production of large amounts of RBCs due to an underlying condition or an external factor. Erythropoietin levels are high in secondary polycythemia and stimulate the production of RBCs.

Write sign and symptoms of polycythemia

Fatigue

Head one

Dizziness

Shortness of breath

Blurred vision

Rudy Complexion (Red or Flush Face)

Angorg retinal vein

Itching (after a warm shower or bath – post-bath pruritus)

Hyper tension

Blood clot formation

Fullness or pain in left upper abdomen

Write diagnostic evaluation of polycythemia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Serum erythropoietin level

ABG Analysis

JAK2 mutation testing

Bone marrow aspiration and biopsy

Erythropoietin stimulation test

Red cell mass measurement

Ultrasound

CT scan Write management of polycythemia

Phlebotomy:

Phlebotomy is the treatment of choice for the management of polycythemia vera. In which (a certain amount) of blood is withdrawn from the body through a vein. So that the hematocrit level can be decreased. (< 42% in females, < 45% in males) The procedure is performed weekly or biweekly.

Hydroxyurea:

Hydroxyurea suppresses the bone marrow’s ability to produce red blood cells.

Interferon alfa:

Use interferon alfa alternately with hydroxyurea in young patients and pregnant patients. which stimulates the immune system so that it can fight against the overproduction of red blood cells.

Aspirin:

Provide low-dose aspirin to reduce the risk of blood clots.

JAK2 inhibitors:

Use of JAK2 inhibitors in cases where hydroxyurea is ineffective or cannot be tolerated. such as ruxolitinib

Antihistamines:

Using an antihistamine drug to relieve itching.

Oxygen Therapy:

Providing oxygen therapy to manage hypoxia in cases with chronic lung disease and sleep apnea.

Treat underlying causes:

Identifying and treating the causes of secondary polycythemia. For example, if the condition of polycythemia is caused by an erythropoietin-producing tumor, surgical removal of the tumor.

Define leukopenia

Leukopenia means low levels of white blood cells in the blood

Decrease in the number of leukocyte Write causes of leukopenia

idiopathic

Bone marrow disorder

Leukemia

Aplastic anemia

Myelodysplastic syndrome

Autoimmune disorders (systemic lupus erythematosus, rheumatoid arthritis)

Medication (chemotherapy agent, antibiotic, antipsychotic)

Radiation therapy

Nutritional deficiency

Congenital disorder (Kostmann syndrome)

Write sign and symptoms of leukopenia (Write sign and symptoms of leukopenia)

Frequent infections

Fever

Chills

Mouth Sore

Sore throat

Fatigue

Swellon lymph node

Gingivitis

Skin lesions

Head one

A muscle

swatting

Write diagnostic evaluation of leukopenia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Bone marrow aspiration and biopsy

Infection screening

Blood culture

Autoimmune markers

Write management of leukopenia

Growth factor:

Using growth factors to stimulate white blood cell production. such as using colony stimulating factor, granulocyte macrophage colony stimulating factor.

Blood Transfusion:

Transfusion of leukocyte rich blood products in cases with severe leukopenia.

Antibiotics:

Using antibiotic drugs to prevent infection.

Bone Marrow and Stem Cell Transplantation:

Stem cell or bone marrow transplantation is performed in more severe cases that have bone marrow failure or cancer.

Treat underlying causes:

Treating causes responsible for leukopenia.

Write nursing management of leukopenia

To monitor patient’s vital signs.

To monitor the patient’s white blood cells regularly.

Use aseptic technique while dealing with the patient.

Provide isolation to the patient.

Assess the patient for any signs and symptoms of infection.

Providing education to patients for self-care activities.

Administer antibiotics to prevent secondary infection.

Administer the medicine prescribed by the doctor.

Monitoring for side effects and effectiveness of medications.

To maintain records and reports.

Define leukocytosis

Leukocytosis means increased number of white blood cells (leukocytes).

Leukocytosis means high levels of white blood cells in the blood

White blood cells are a type of blood cell. White blood cells are part of the immune system that help the body fight infection.

When any type of infection is present in the body, the level of WBCs is high.

Write causes of leukocytosis

infection

Inflammation

Stress (Physical and Emotional Stress)

Leukemia

Allergic reaction

Medication (corticosteroids)

Write sign and symptoms of leukocytosis (Write sign and symptoms of leukocytosis)

The level of WBCs increases mainly during infection so that leukocytosis presents with symptoms similar to those seen in infection.

Fever

Chills

Fatigue

weakness

Cough

Sore throat

Joint pain

Head one

Abdominal

Pur appetite

Weight loss

Write diagnostic evaluation of leukocytosis

History Collection

Physical Examination

Complete blood count

Differential count

Peripheral blood smear

Bone marrow biopsy

Flow cytometry

Write management of leukocytosis

There is no specific treatment for leukocytosis. WBCs return to normal levels on their own. But treating the causes responsible for leukocytosis.

Identify underlying cause: Identify and treat the underlying cause of leukocytosis.

Symptomatic Management: Management of symptoms like fever, headache, chills, pain.

In case of infection: Antibiotics, antifungal and antiparasitic drugs are given to treat bacterial, fungal, parasitic infections.

Inflammatory and Autoimmune Conditions: Inflammatory and autoimmune conditions provide NSAIDs, corticosteroids and immunosuppressive drugs.

In Case of Allergic Reaction : If leukocytosis is observed due to allergic reaction, antihistamine and corticosteroid drugs are given to manage the allergic reaction.

In case of blood cancer: Providing chemotherapy, radiation therapy and target therapy to manage blood cancer.

Define Leukemia

Leukemia is also known as blood cancer.

Leukemia is derived from the Greek words leukos (leucos) and aima (ameia) where leukos means white and aemia means blood.

Cancers of blood forming tissue (spongy like tissue where blood cells are made) and bone marrow are known as leukemia.

In which persistent and uncontrolled, immature and abnormal WBC production is seen.

Due to which there is no space for normal blood production. That is, there is a decrease in the production of red blood cells, white blood cells and platelets.

Leukemia is a major neoplastic disease of childhood.

Write classification of the leukemia

1) Acute leukemia
2) Chronic leukemia

1) Acute Leukemia :

Acute leukemia is the most common type seen in children. It involves rapid production of immature white blood cells and requires immediate treatment.

There are two types of acute leukemia as follows:

a) Acute lymphocytic leukemia
b)Acute myeloid leukemia

a) Acute lymphocytic leukemia :

Acute lymphocytic leukemia affects lymphoid cells. Which is progressing quickly. Acute lymphocytic leukemia is more common in younger children.

b) Acute myeloid leukemia :

Myeloid cells are affected in acute myeloid leukemia. Which progresses rapidly.

2) Chronic Leukemia :

Chronic leukemia occurs most commonly in older people. In which white blood cells are produced slowly, it takes months to years to develop. Chronic leukemia does not require immediate treatment.

Chronic leukemia is also of two types as follows:

a) Chronic lymphocytic leukemia
b) Chronic myeloid leukemia

a) Chronic lymphocytic leukemia :

Lymphoid cells are affected in chronic lymphocytic leukemia. Which develops slowly. Chronic lymphocytic leukemia is more common in adults and old age.

b) Chronic myeloid leukemia :

Myeloid cells are affected in chronic myeloid leukemia. Which progresses slowly.

Write cause and risk factor of the leukemia

Genetic factor

Chromosomal Abnormalities

Family history

Genetic disorders (Down syndrome)

Environmental Factors

Exposure to Chemicals

Exposure to radiation

smoking

Praveyas Cancer Treatment

Blood disorders

Viral infection

Write sign and symptoms of the leukemia

Fatigue

Wickness

Frequent infections

Fever

Chills

Easy bleeding and bruising

Nose bleed

Bleeding from gums

Pale skin

Shortness of breath

Swellon lymph node

Enlarged liver or spleen

Bone or joint pain

Night sweats

Weight loss

Confusion

Balance problem

Write diagnostic evaluation of leukemia

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Biochemical test

Bone marrow aspiration and biopsy

Karyotyping

Fluorescence in situ hybridization

Flow cytometry

Immunohistochemistry

Chest X Ray

CT scan

MRI

Write management of leukemia

Chemotherapy: Chemotherapy is the primary treatment for leukemia. It contains a chemical that kills abnormal cells. It is available in tablet or injectable form.

Targeted therapy: Targeted therapy involves the use of a specific drug that targets a specific genetic mutation or abnormality. such as tyrosine kinase inhibitors

Radiation therapy: Radiation therapy uses X-rays or some specific high-energy beams. which damages abnormal cancerous cells and inhibits their growth. Radiation therapy is also used before stem cell transplants.

Stem Cell Transplantation: In stem cell transplantation or bone marrow cell transplantation, unhealthy bone marrow is replaced with healthy bone marrow. In which autologous (patient’s own cells) or allogenic methods (donor cells) are used.

Immunotherapy: Immunotherapy is a treatment for cancer. Which helps the body’s immune system to fight against cancer. Examples include monoclonal antibodies, CAR-T cell therapy, immune checkpoint inhibitors

Define multiple myeloma

Multiple myeloma is also known as ‘Kahler disease’.

Multiple myeloma is a type of blood cancer in which malignancy occurs in the plasma cells i.e. plasma cell cancer.

A plasma cell is a type of white blood cell found in the bone marrow.

Multiple myeloma plasma cells become cancerous and multiply and damage the bones, immune system, kidneys, and red blood cells.

Write causes of multiple myeloma

The exact cause of multiple myeloma is unknown but appears to be due to genetic, environmental and lifestyle factors.

Chromosomal abnormality

Exposure to radiation

Exposure to Chemicals

Viral infection

Immune system dysfunction

Write sign and symptoms of multiple myeloma (Write sign and symptoms of multiple myeloma)

Multiple myeloma has a variety of signs and symptoms. In which mainly ‘CRAB’ symptoms are seen. That is, calcium elevation, renal impairment, anemia and bone lesions are seen.

Bone Pain: Pain is most commonly seen in the back, ribs, hips.

Osteolytic lesions: Bone lesions are seen and the bone becomes brittle and bone destruction and fractures are also seen.

Hypercalcemia: The level of calcium in the blood increases, causing symptoms such as nausea, vomiting, constipation, frequent urination, muscle weakness, increased thirst, confusion and coma.

Renal Impairment: Increased levels of monoclonal protein cause kidney damage.

Anemia: Suppression of bone marrow function results in a decrease in red blood cell, white blood cell and platelet count and an anemic condition. Due to which fatigue, weakness, pallor, shortness of breath are seen.

Frequent infections : Frequent infections like pneumonia, urinary tract infection, sinus infection are seen.

Neurological symptoms: Spinal cord compression and peripheral neuropathy may be seen. Pain, tingling sensation and numbness may be seen in the hand and feet.

Hyperviscosity syndrome: An increase in the level of M protein in the blood causes an increase in the viscosity of the blood, causing headaches, blurred vision, dizziness and confusion.

Cryoglobulinemia: Abnormal proteins called cryoglobulins clump together on exposure to cold temperatures and dissolve on exposure to warm temperatures.

Bleeding and clotting issue: Prolonged bleeding, nose bleed and bruising can be seen from cuts.

Write diagnostic evaluation of multiple myeloma

History Collection

Physical Examination

Complete Blood Count (CBC)

Serum Protein Electrophoresis (SPEP)

Urine Analysis and Urine Electrophoresis

Immunofixation Electrophoresis

x ray

CT scan

MRI

PET scan

Bone marrow aspiration and biopsy

Flow Cytometry and Cytogenetics

Write management of multiple myeloma

Chemotherapy:

Chemotherapy using bortezomib, lenalidomide, and dexamethasone is used to shrink myeloma cells.

Target therapy:

Targeted therapy involves targeting proteins in myeloma cells to inhibit their growth. So that the growth of myeloma cells can be stopped.

Immunotherapy:

Immunotherapy is used to get the immune system to recognize and destroy myeloma cells. Ex. daratumumab, elotuzumab

Stem Cell Transplant:

A stem cell transplant is performed to restore bone marrow function, along with high doses of chemotherapy.

Radiation therapy:

Radiation therapy is given to target localized myeloma tumors as well as to relieve bone pain and manage spinal cord compression.

Corticosteroids:

Corticosteroid drugs are used to reduce inflammation. Like dexamethasone, prednisolone

Bisphosphonates:

Providing bisphosphonates to strengthen bones, relieve bone pain, and reduce the risk of bone fractures. Ex. Zoledronic acid, pamidronate

Antibiotics:

Using antibiotic drugs to prevent infection.
: Bleeding disorder

Define thrombocytopenia

Thrombocytopenia means low platelet count.

A low number of platelets in the blood is known as thrombocytopenia.

Platelet is also known as thrombocyte. Platelets are a type of blood cell.

Platelets play an important role in blood clotting and controlling bleeding.

Write causes of thrombocytopenia

Three causes are mainly responsible for thrombocytopenia:
✓ Decreases platelet production
✓ Increase platelet distribution
✓ Platelet sequestration

✓ Decrease platelet production:

Low production of platelets occurs due to the following reasons.

Aplastic anemia

Leukemia

Myelodysplastic syndrome

Viral infections that affect bone marrow (HIV, Epstein Barr virus, hepatitis C)

Vitamin B12 Deficiency

Folate Deficiency

Chemotherapy drugs

Certain antibiotics (linezolid)

Radiation therapy

Alcohol abuse

✓ Increase Platelet Destruction :

Destruction of platelets is more common due to following reasons.

Immune thrombocytopenia

Drug thrombocytopenia

Systemic lupus erythematosus

Disseminated intravascular coagulation

Thrombotic thrombocytopenic purpura

Hemolytic uremic syndrome

Sepsis

Dengue fever

HELLP syndrome

✓ Platelet Sequestration :

Splenomegaly means that due to enlargement of the spleen, a large amount of platelets are trapped in it. Splenomegaly is seen for the following reasons.

Cirrhosis of liver

Gaucher disease

lymphoma

Write sign and symptoms of thrombocytopenia

Bleeding on the skin

Petechiae (small, red, purple spots on the skin)

Purpura (large purple, brown spots or patches on skin)

Ecchymosis (Large Area of ​​Bruises)

Prolonged bleeding from cuts and minor injuries

Nose bleed

Bleeding in gums (gingival bleeding)

Heavy menstrual bleeding (menorrhagia)

Blood in urine

Blood in stool

Fatigue

weakness

Head one

Dizziness

Write diagnostic evaluation of thrombocytopenia

History Collection

Medical Examination

Complete blood count

Peripheral blood smear

Bone marrow aspiration

Bone marrow biopsy

Reticulocytes count

• Antiplatelet antibody testing

CT scan

Ultrasound (check the size of spleen)

Serological study (for infection)

Write medical management of thrombocytopenia

Blood / Platelet Transfusion: Transfuse platelets in conditions with severe thrombocytopenia.

Treat underlying causes: Identify and treat underlying causes of thrombocytopenia. So that platelet level can be prevented as it decreases.

Write nursing management of thrombocytopenia

Protecting the patient from minor injuries and trauma.

Educating patients about skin care.

Keep the skin clean and moisturized.

Keep checking if any signs of bleeding are present.

If the patient is constipated, give a laxative.

Asking the patient to use an electrical razor.

Avoid invasive procedures.

Ask the patient to avoid taking medications of the NASID group as well as aspirin.

Define idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura is also known as ‘immune thrombocytopenic purpura’.

It is an autoimmune disorder in which the body mistakenly attacks and destroys platelets.

Hence in this condition the platelet count in the body is lower than its normal level i.e. low platelet count is observed.

Platelets are cells important for blood clotting and stopping bleeding.

Due to the low platelet count in the body, easy bruising and bruising occurs in the body and spontaneous hemorrhage occurs in the skin and mucous membranes.

Because of this, petechiae, ecchymosis and hematoma are also seen in the skin.

Write cause or risk factor of immune thrombocytopenic purpura

The exact cause of immune thrombocytopenic purpura is unknown. But the following factors can cause immune thrombocytopenic purpura

Autoimmune response

Viral infection (hepatitis, HIV)

Genetic factor

Environmental Factors

Medication (sulfa, quinine, antibiotics)

Other autoimmune disorders

Pregnancy

Write classification of the immune thrombocytopenic purpura

There are two types of immune thrombocytopenic purpura:
1) Acute immune thrombocytopenic purpura
2) Chronic immune thrombocytopenic purpura

1) Acute immune thrombocytopenic purpura,

Acute immune thrombocytopenic purpura is the most common type that occurs most commonly in childhood. It is usually seen after any viral infection. It has a sudden onset. Acute immune thrombocytopenic purpura is self-limiting, meaning it resolves within months. Treatment is not required to treat it. It gets resolved on its own.

2) Chronic immune thrombocytopenic purpura

Chronic immune thrombocytopenic purpura is a long-lasting disease commonly seen in adults. Chronic immune thrombocytopenic purpura usually occurs for more than 6 months and requires treatment to cure it.

Write sign and symptoms of the immune thrombocytopenic purpura (Write sign and symptoms of immune thrombocytopenic purpura)

Petechiae (small red, purple spots on the skin)

Purpura (larger purple and red bruises)

Easy Bruising

Ecchymosis

Mucosal bleeding

Nose bleed

Bleeding from the gums

Prolonged bleeding from cuts

Blood in urine (hematuria)

Blood in stool (haematochezia, melena)

Heavy or prolonged menstrual bleeding

Intracranial hemorrhage

Fatigue

Wickness

Shortness of breath

Write diagnostic evaluation the idiopathic thrombocytopenic purpura (Write diagnostic evaluation idiopathic thrombocytopenic)

History Collection

Physical Examination

Complete blood count

Peripheral blood smear

Bonmaro Studies

Bone marrow aspiration

Coagulation study

Liver function test

Renal function test

Direct antiglobulin test

Antiplatelet antibody

Write management of idiopathic thrombocytopenic purpura

Corticosteroids:

Corticosteroids are the treatment of choice for the management of ITP to suppress immunity and increase platelet count. Prednisolone and dexamethasone are used as corticosteroids.

Intravenous immunoglobulin (IVGI):

Administer intravenous immunoglobulin in cases with severe bleeding and before surgery. IVGIs rapidly increase blood counts.

Anti-D immunoglobulin: Anti-D immunoglobulin is given in severe cases and in cases with active bleeding when rapid response is required.

Rituximab : Anti-CD20 monoclonal antibody used to deplete B cells. which reduces the production of antibodies against platelets. In addition, cyclophosphamide is often used along with it.

Thrombopoietin receptor antagonists: In patients with chronic ITP that does not respond to other treatments, thrombopoietin receptor antagonists are used to stimulate the production of platelets. For example Eltrombopag, Romiplostim

Define Hemophilia

Hemophilia is an inherited bleeding disorder in which the blood does not clot normally due to a deficiency of coagulation factors (factors 8, 9, and 11) resulting in bleeding.

A specific protein is required for blood to clot. This specific protein is known as coagulation factor. Deficiency of this coagulation factor is seen in hemophilia. Due to which the blood clotting mechanism is disrupted and the blood does not clot. Hence, when a minor injury or trauma occurs, the blood does not clot and the bleeding continues.

Hemophilia is usually found in excess in feces.

Write types of hemophilia

Hemophilia is divided into 3 types based on its deficient clotting factor:

1) Hemophilia A
2) Hemophilia B
3) Hemophilia C

1) Hemophilia A :

Hemophilia A is the most common (80%) type of hemophilia characterized by deficiency of clotting factor VIII (8).

2) Hemophilia B

Haemophilia B, also known as ‘Christmas disease’, usually involves clotting factor IX(9) deficiency.

3) Hemophilia C.

Hemophilia C is rare. which is caused by deficiency of factor XI (11).

Other types of hemophilia

Parahemophilia:

Parahemophilia is also known as ‘Owren’s disease’. which occurs due to deficiency or dysfunction of clotting factor V (5).

Accurative Haemophilia:

In acquired hemophilia, antibodies produced by the body attack clotting factors (mainly factor VIII (8)) and cause the condition of hemophilia.

Inheritance pattern hemophilia

Defective genes for hemophilia are located on the X chromosome. That is, hemophilia is an X linked genetic disorder.

Both male and female have 23 pairs of chromosomes. Out of which 22 pairs of chromosomes are identical in male and female. On the 23rd, the a becomes different which determines the gender of the person.

Females have two X chromosomes while males have one X chromosome and one Y chromosome.

X chromosome is passed from mother to son while Y chromosome is passed from father to son.

Hence, if the defective gene for hemophilia is present on one of the two X chromosomes of the mother, the son has a 50% chance of developing hemophilia because the son has only one X chromosome which is inherited from the mother.

While a girl does not have the condition of hemophilia due to having two X chromosomes, she behaves as a carrier. (Because he gets one X chromosome from his mother and one X chromosome from his father and the X chromosome from his father is normal, the condition of hemophilia is not seen.

Hence there is a 50% chance of a girl being a hemophilia carrier.

The condition of hemophilia is rarely seen in girls. When the father has the condition of hemophilia and the mother is a carrier, the condition of hemophilia is seen in the girl.

Because one abnormal X chromosome inherited from the father and another abnormal X chromosome inherited from the mother causes the condition of hemophilia in a girl. If a normal X chromosome is inherited from the mother, the condition of hemophilia is not seen in the girl.

Explain sign and symptoms of the hemophilia (Explain sign and symptoms of hemophilia)

Excessive bleeding

Most common bleeding occurs in joint (knee, elbow joint are most common) – hemarthrosis

Bleeding from muscles and soft tissue

Bleeding in brain, gastrointestinal tract

Bleeding after cut, injury, dental procedure, surgical procedure

Bleeding after vaccination

Prolonged bleeding from minor wound

Unexplained and excessive bruising

Blood in urine (hematuria)

Blood in stool (haematochezia, melena)

Nose bleeds (epistaxis)

Intracranial hemorrhage

Head one

Vomiting with hematemesis

Double vision

Lethargy

weakness

slur speech

Joint pain, swelling (due to hemarthrosis)

Decreases range of motion

Explain the Diagnostic evaluation of the hemophilia

History Collection

Physical Examination

Clotting factor assessment

Coagulation study

Prothrombin time

Activated partial thromboplastin time

Complete blood count

Genetic Testing (DNA Analysis)

Gene Analysis

Chorionic villus sampling test

Explain the management of hemophilia

Replacement therapy:

Replacement therapy is the main treatment for hemophilia, in which clotting factor concentrates are injected directly into the bloodstream. So that deficiency of clotting factor can be removed. Clotting factor VIII is injected for hemophilia A, clotting factor IX for hemophilia B.

Desmopressin (DDAVP):

Desmopressin is used to treat mild hemophilia A. Desmopressin is a man-made hormone that stimulates the release of factor VIII stored in body tissues. Desmopressin is mainly given as an injectable or through a nasal spray.

Antifibrinolytic Medicines:

Provide antifibrinolytic medicine to prevent breakdown of fibrinogen and breakdown of blood clot. Such as tranexamic acid, aminocaproic acid.

Gene therapy:

Gene therapy is used to correct the defective gene in hemophilia. Research on which is still going on.

Avoid Certain Medications:

Do not use non-steroidal anti-inflammatory drugs and aspirin as they increase bleeding.

Physical Therapy:

Regular physical therapy strengthens muscles and joints.

Vaccination:

The patient received hepatitis A and hepatitis B vaccine. Because the chances of infection increase in such people.

Acquired coagulation disorder

Define vitamin k deficiency

Vitamin K is a fat soluble vitamin. Vitamin K plays an important role in the synthesis of blood clotting factors. Such as prothrombin, factors VII, IX, X. These blood clotting factors are essential to clot bleeding during injury.

In addition, vitamin K is also necessary for the production of proteins necessary for bone mineralization.

Hence when there is vitamin K deficiency excessive bleeding and bruising occurs due to lack of production of vitamin K dependent coagulation factor.

Write causes of vitamin K deficiency

Poor dietary intake of vitamin K

Malabsorption (Celiac Disease, Crohn’s Disease, Cystic Fibrosis)

Liver disease (hepatitis, cirrhosis)

Medication (long term use of antibiotics, anticoagulant, antacid)

Chronic kidney disease

Severe malnutrition

Write sign and symptoms of vitamin K deficiency

Easy Bruising

Excessive bleeding

Bleeding from gums

Nose bleed

Heavy menstrual bleeding

Gastrointestinal bleeding

Blood in urine

Blood in stool

Hematoma

Write diagnostic evaluation of vitamin K deficiency

History Collection

Physical Examination

Prothrombin Time (PT) and International Normalized Ratio (INR)

Activated Partial Thromboplastin Time (APTT)

Vitamin K levels

Liver function test

Kidney function test

Write management of vitamin K deficiency

Oral or Injectable Vitamin K: Providing vitamin K to the patient orally or in injectable form mainly using phytonadione (vitamin K1). The phytonadione dose and route are determined based on the severity of the deficiency.

Mild Deficiency: Provide 1-2 mg orally daily in cases with mild deficiency.

Severe Deficiency: In cases with severe deficiency, provide 1-10 mg intravenously or intramuscularly. How much vitamin K to administer depends on the severity of the bleeding and the patient’s condition.

Dietary Intake: Ask the patient to consume a vitamin K rich diet. Like green leafy vegetables, fish, meat, dairy products

Treat Underlying Causes: Identify and treat underlying causes of vitamin K deficiency. such as malabsorption, interfering medications.

Define disseminated intravascular coagulation (DIC)

Disseminated intravascular coagulation is also known as ‘consumptive coagulopathy’.

Disseminated intravascular coagulation is a serious and complex medical condition characterized by the formation of blood clots throughout the body, causing blockage of small blood vessels.

In this condition, the blood clotting mechanism of the body is activated i.e. the clotting cascade is activated. This abnormal activation leads to the formation of blood clots in the body and causes blockages in the body’s small blood vessels, resulting in multiple organ failure.

Write causes of disseminated intravascular coagulation

Bacterial, viral, fungal, parasitic infections

Sepsis

Trauma and Severe Injury (Burns, Head Injury)

Hematologic Cancer (Acute Promyelocytic Leukemia)

Obstetric complications

Placental abruption

Amniotic fluid embolism

Preeclampsia and Eclampsia

Retained Dead Fetus Syndrome

Aortic aneurysm

Giant hemangioma

Hemolytic reaction from blood transfusion

Thrombotic thrombocytopenic purpura

Severe liver dysfunction

Toxins from bacterial infections (Clostridium species)

Snake bite

Surgery (cardiopulmonary bypass)

Write sign and symptoms of disseminated intravascular coagulation (Write sign and symptoms of disseminated intravascular coagulation)

Spontaneous bleeding from gums, nose and surgical site

Bruising

Petechiae (small red spots)

Heavy menstrual bleeding

Blood in urine

Blood in stool

Blood Clot in Vein and Artery

Cyanosis

Kidney failure

Liver dysfunction

Respiratory distress

Hypotension

Rapid heart beat

Confusion

Altered mental status

Weakness and Fatigue

Fever

Malays

Write diagnostic evaluation of disseminated intravascular coagulation (Write diagnostic evaluation of disseminated intravascular coagulation)

History Collection

Physical Examination

Prothrombin Time (PT)

Thrombin time

Activated Partial Thromboplastin Time (APTT)

Platelet count

Fibrinogen level

D-dimer test

Fibrin Splint Products (FSP)

Schistocytes

Write management of disseminated intravascular coagulation

The main aim of DIC is to control bleeding and manage clotting problems.

Blood product replacement:

Platelet Transfusion: Platelet transfusion in cases with significant bleeding as well as in cases with low platelets.

Fresh Frozen Plasma (FFP): Using fresh frozen plasma to replace blood clotting factors.

Cryoprecipitate: If fibrinogen levels are low, use cryoprecipitate to replace it.

Packed Red Blood Cells (PRBCs): Using PRBCs to maintain adequate hemoglobin levels and red blood cell levels.

Anticoagulant therapy: Use anticoagulant therapy such as heparin in cases with thrombosis and in patients at low risk of bleeding.

Antifibrinolytic agent : Use of antifibrinolytic agent like tranexamic acid, aminocaproic acid. which prevents the breakdown of fibrin. (Fibrin is a type of protein required for blood clot formation) Avoid antifibrinolytic drugs in patients at high risk of thrombosis.

Recombinant activated protein C: Recombinant activated protein C is used to treat DIC with severe sepsis. Recombinant activated protein C prevents blood clot formation and reduces inflammation.

Vitamin K: Administer vitamin K in cases with vitamin K deficiency.

Treat Underlying Causes: Identify and treat underlying causes of disseminated intravascular coagulation.