...Hypertension Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Hypertension is the consistent elevation of systemic arterial blood pressure. It is also the most common primary diagnosis in the United States (Brashers, 2010). It is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Over the past several decades, extensive research, widespread patient education, and a concerted effort on the part of health care professionals have led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension. I. Prevalence of disease (in US) and risk factors Hypertension is a major U.S. health problem affecting some 50 million individuals. Approximately 65% of Americans older than age 60 have hypertension. Of those diagnosed with hypertension, over 30% do not have their hypertension adequately treated and controlled. Ninety to ninety-five percent of hypertension is idiopathic and called primary hypertension. Five to ten percent of hypertension is the result of an identifiable etiologic cause and is called secondary hypertension. According to Center of Disease Control (CDC) the prevalence of hypertension, 45.3% had been treated...
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...------------------------------------------------- Hypertensive emergency From Wikipedia, the free encyclopedia A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be substantially lowered over minutes to hours with an antihypertensive agent. Contents [hide] * 1 Treatment * 2 Incidence * 3 Definition * 3.1 Hypertensive emergency as a generic term * 4 Pathophysiology * 5 Mortality * 6 Clinical history * 7 References * 8 See also | ------------------------------------------------- [edit]Treatment Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensiveeffect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used. It is also important that the blood pressure is lowered not too...
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...Hypertension or High blood pressure is a prevalent cardiovascular disease in the United States and other nations around the world. It is estimated that 1 billion is affected with the disease and about 7.1 million hypertension related mortalities annually. It is a condition in which the long-term force of blood against artery walls is high enough to ultimately cause heart attack, aneurysm, stroke or left ventricular hypertrophy leading to congestive heart failure. Many people with hypertension do not realize they have because the symptoms are subtle and that it generally develops over a long period of time. Most often, vital organs like the kidneys and eyes may damage or other diseases may occur before it is detected; for this reason, it is often called the "silent killer (American Heart Association, 2014). According to Woo & Wynne (2012), a report from the World Health Organization indicates that suboptimal blood pressure higher than 115mm Hg (systolic) is liable for 62% of all cardiovascular disease and 49% of all ischemic heart disease. A normal blood pressure level is systolic reading of blood pressure (SBP) less than 120mmHg with diastolic level (DBP) less than 80mmHg. Hypertension disease has the following stages. A pre-hypertensive level is SBP 120-139, and DBP 80-89. Hypertension stage 1 is SBP 140-159, with DBP of 90-99. Hypertension stage 2 is SBP greater than or equal to 160 with DBP of 100 or more. Stress and emotional tension may temporarily increase blood pressure;...
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...kills more people than the next four causes of death combined, including cancer, chronic lower respiratory diseases, accidents, and diabetes” (Ignatavicius & Workman, 2010, p. 704). In order to manage the disease effectively, it is of major importance to identify risk factors. The purpose of this paper is to discuss several cardiovascular risk factors and how they contribute to the pathophysiology of CVD. Patient Profile Mrs. G.Y. is a 71-years old Hawaiian female of Chinese descent, admitted to the hospital for chest pain. Upon admission to the hospital, she was complaining of generalized weakness, chest pain, and dyspnea with any physical activity. Her health history includes: hypertension, cardiovascular disease, hyperlipidemia, aortic stenosis and osteoporosis. Past surgical procedures include tubal ligation. She is on a cardiac diet, is allergic to aspirin, never smoked, and never used illegal drugs. Cardiovascular Risk Factors By taking a quick glance at her medical record, she is at risk for cardiovascular disease, due to the fact that she is a postmenopausal female, over 65, has hypertension, she lives a sedentary life, and she has aortic stenosis. Other cardiovascular risk factors include cigarette smoking and obesity, but fortunately she does not smoke, nor is she obese. Mrs. G.Y. is 71 years old, and several physiologic changes occur with aging, and these changes result in a loss of cardiac reserve. Some of these physiologic changes include calcification of mitral...
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...10/10. She told the Emergency Department staff her foot began hurting about a week ago and had been becoming more and more tender and slightly more discolored as each day passed. She thought it would “go away with time.” When she awoke this morning, her toes were purple in color, and she was unable to touch them secondary to the immense pain. Her husband drove her to the hospital immediately. Her weight is 65.0 kg. Other findings include normal heart tones, clear lung sounds, positive bowel sounds and clear yellow urine from a urinary catheter inserted in the emergency department. Her medical history consists of hypertension, partial lumpectomy of the right breast seven years ago, alcohol abuse and hyperlipidemia. She is allergic to angiotensin converting enzymes inhibitors and angiotensin receptor blockers. She takes metoprolol 25mg twice per day at home for hypertension management. She has been married for 25 years and has two adult children. She reports that she smokes one pack of cigarettes per day and generally drinks two distilled alcoholic drinks per day. Blood work was drawn, but the results are not yet available. The emergency department team has transferred the client to the cardiac catheterization laboratory after inserting left jugular venous access and a urinary catheter. Healthcare Provider’s Orders: Cath Lab orders:...
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...Pathophysiology for G,L ESRD: renal failure is progressive, from acute to chronic, then end stage. In ESRD, the kidneys fail to function. Once in chronic renal failure, damage to kidneys is progressive and irreversible. The nephrons are damaged, can't function and don't recover. Surviving nephrons then hypertrophy and increase their rate of filtration, reabsorption, and secretion. Compensatory excretion continues as GFR decreases. This leads to retention of water, waste products, oliguria, and even hypertension because the kidneys cannot excrete. Also due to ESRD, BUN, creatinine, are high, GFR decreases, resulting anemia, metabolic acidosis. Hypertension: progressive damage to major organs like the kidneys, brain or heart, lead to hypertension. The kidneys, through the renin-angiotensin system help control blood pressure, by releasing angiotensin II a vasoconstrictor, and aldosterone, which leads to sodium and water retention. Impairment in this system affects blood pressure. Also changes in blood vessels cause hypertension, if their force of contractility is increased due to blockage or structural changes. Diabetes mellitus: it is known as type 2 diabetes mellitus, and is as a result of relative insulin deficiency. The pancreas produces either normal or excessive amounts of insulin but the body s unable to use it effectively, so glucose levels remain elevated, thus know as insulin resistance. Also, failure of the pancreas to produce enough insulin to overcome this insulin...
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...According to Brown & Edwards (2012) hypertension is defined as persistent systolic blood pressure greater than or equal to 140mmHg and a diastolic reading greater than or equal to 90mmHg on 2 consecutive clinician visits. Thus resulting in the heart and the vessels being put under great strain. There are two classifications of hypertension these being: Primary Hypertension, which is an increased blood pressure with an unidentified cause, it accounts for 90-95% of all cases of hypertension (Brown & Edwards, 2012). The second is secondary hypertension, which is an increase in blood pressure with a known cause and can be identified and corrected. Secondary hypertension accounts for 5-10% of hypertension in adults and 80% in children (Brown & Edwards, 2012) Patients who suffer hypertension have an increased peripheral resistance accounting for the high pressure, whilst cardiac output remains normal, while arteries and arterioles remain limited to maintain that constant flow of blood. Peripheral resistance is the resistance to blood flow determined by the tone of vascular musculature and diameter of the blood vessels (Crisp & Taylor, 2009). Peripheral resistance is blood circulating through arteries, arterioles, capillaries, venules and veins. Arteries and arterioles are surrounded by smooth muscle, which contracts and relaxes to change the size of the lumen, the smaller the lumen the greater the peripheral resistance to blood flow. As the pressure rises the arterial blood pressure...
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...Postpartum Hemorrhage Learning Objectives: * Performs a basic physical assessment of the postpartum patient (APPLYING) * Identifies the signs and symptoms of postpartum hemorrhage (REMEMBERING) * Determines the most likely cause of hemorrhage (ANALYZING) * Performs appropriate nursing management interventions for the patient experiencing postpartum hemorrhage (APPLYING) * Evaluates effectiveness of interventions and revises plan of care as indicated according to patient’s condition and assessment (EVALUATING) * Prioritizes the implementation and approach to the nursing care of a patient with post partum hemorrhage when working with other health care team members (ANALYZING) Prep Questions 1. What is the normal location of the fundus two hours post-vaginal delivery? * Immediately after delivery, the uterus is about the size of a large grapefruit and can be palpated midway between the symphysis pubis and umbilicus and in the midline of the abdomen. Within 12 hours the fundus rises to about the level of the umbilicus 2. What assessments are vital for the nurse to perform on the postpartum patient? * Vital signs, skin color, location and firmness of fundus, amount and color of lochia, perineum (edema, episiotomy, lacerations, hematoma), presence degree and location of pain, IV infusion assessments, urinary output, status of abdominal incision and dressing, level of feeling and ability to move if regional anesthesia was used 3. What...
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...Running head: CARDIOVASCULAR PAPER 1 Cardiovascular Paper: R.G.’s Risk Factors for Cardiovascular Disease CARDIOVASCULAR PAPER 2 Cardiovascular Paper: R.G’s Risk Factors for Cardiovascular Disease In almost every year since 1900, cardiovascular disease has been the number one cause of death in the United States. Nearly 2300 Americans die of CVD each day, and average of one death every 38 seconds. This disease kills more people than the next four causes of death combined, including cancer, chronic lower respiratory diseases, accidents and diabetes. Of particular concern is that CVD is the leading cause of death for women (Ignatavicius and Workman, 2013). Risk Factors Gender According to, Huether and McCance (2012) more women in the United States die from coronary artery disease and stroke than from all cancers combined. Women have a higher rate of CAD related mortality than men, in part because of under diagnosis and treatment. Menopause is associated with increased exposure to risk factors and poor endothelial healing. Endogenous estrogen is said to be protective of vascular function and when this is reduced after menopause hits the risk of CAD increases. Postmenopausal women are two to three times more likely than premenopausal woman to have CAD. Diabetes Diabetes mellitus is an extremely important risk factor for CAD. Insulin resistance and diabetes have multiple effects on the cardiovascular system including endothelial damage, thickening...
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... Increase water reabsorption by renal tubule Dilation and enlargement of heart chambers Stretching of muscle fibers of the heart Increase contraction (Frank-starling law) Increase O2 requirement to perform work Presence in the skin/skin changes Tissue Hypoperfusion s/sx: Weakness, fatigue, pallor. Pale nail beds and lips Increase cardiac workload, leading to overworked heart Heart failure Increased Fluid backup into the lungs Increased Pulmonary Pressure Impaired Gas exchange s/sx; dry Cough, Fatigue, Orthopnea, Irritability, Crackles Legend: pathophysiology signs/symptoms lab result diagnosis Kidney hypoperfusion Decrease glomerular filtration rate Decrease nephron function Heart failure Renal Failure (impaired renal excretory ability) Increase...
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...Case Study 11 Karley Lapointe Liberty University Abstract C.W. is a patient with a gastrointestinal bleed that produced a duodenal ulcer. This ulcer then produced a bloody diarrhea stool. C.W. Was brought to the emergency room with by his wife for having bloody diarrhea for three days and was presenting signs of weakness and hypotension. C.W. underwent surgery for his gastrointestinal bleed and then was admitted to the hospital for having a fluid volume deficit, due to his diarrhea and bleed. C.W. being volume deficit made his fluid, electrolyte and blood levels become very abnormal. His medication that he was on for prior health history was causing some of his levels to rise and drop. He has a past medical history of cardiovascular problems, which were described and attributed to his current admitting problems. While at the hospital he went into sinus tachycardia and was placed on a Swan-Ganz catheter. One of the main goals for treating C.W. is to control his tachycardia and control his levels. He has some serious cardiovascular conditions that can not be healed but medical professionals, using education and medication , can better his quality of the life he has left. Patient C.W., a 70-year-old male, was admitted to the hospital at 0430 with a 25-X15-mm duodenal ulcer causing a gastrointestinal bleed, which was presented by “ dark red “ bloody diarrhea. His wife states that he has had diarrhea for 3 days with “dark red” stool starting the night before. She states that...
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...Question 1.1 Identify two (2) likely medical diagnoses for his presenting condition. Provide a rationale for your answer including the underlying pathophysiology and presenting clinical symptoms. 1. Congestive Heart Failure, (CHF) occurs when the heart cannot pump sufficient blood to meet the body’s demands where weakened chambers allow blood to pool triggering fluid retention in lungs, legs and abdomen (Figueroa & Peters, 2006). The patient has left sided congestive heart failure where left ventricle is not pumping blood sufficient blood out of the lungs/pulmonary vein sufficiently. The lungs become over saturated with blood and the pressure from the right side causes a shift of fluid from the intravascular space into the lungs causing increased respiratory rate and impaired gas exchange. The patient’s symptoms are shortness of breath and cough, swollen ankles due to the excess fluid build up and fatigue. X-ray shows congestion in the middle and lower lungs. The patient was also taking digoxin on admission which is a drug commonly used for treating patients with CHF (Figueroa & Peters, 2006). 2. Digoxin toxicity, Digoxin toxicity is caused by high levels of digoxin in the body a drug Mr Marshall is currently prescribed. His digoxin levels are 2.4 ng/mL and the therapeutic range is 0.6 to 1.3 ng/mL showing increased levels beyond the therapeutic range (Chan, Bradley & Harrigan, 2002). Mr Marshall’s irregular pulse as well as his nausea and vomiting are clinical symptoms...
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...Critical Pathway: Case Study of Chronic Renal Failure Advanced Pathophysiology NURS 5104 October 4, 2013 Critical Pathway: Case Study of Chronic Renal Failure I. Introduction Mr. P. J., a 38-year-old African American male, presented to the Emergency Department by the rescue squad team, with a six day old complaint of increased swelling of the bilateral lower extremities, unusual weight gain, and a feeling of ‘I can not breathe’ per patient. Patient was sent as a direct admit to the Intensive Care Unit (ICU) and placed on 2 liters NC with hydration and adult special care monitoring. Vital signs were taken by the paramedic enroute revealing the following: Ambulance Vitals: * BP 202/112 * Pulse 101 * Respirations 20 * O2 86% before O2 * Temp. 98.4 * Height 5’10 Patient stating * Weight 222 lbs. Patient stating (weighed the day before) The paramedic started a 20 gauge IV into Mr. J’s right antecubital and started him on 2 liters nasal cannula; due to the “presence of crackles no Procardia was administered” (J. Madden, personal communication, August 14, 2013). The paramedic monitored the vitals and reported to medical control the situation and estimated time of their arrival in five minutes. Mr. P. J. has been married to K for twenty years and they have one child, a twelve-year-old daughter. Mr. P. J. has worked in construction for twenty years; Mr. J stated working on his feet all day he noticed the swelling six days ago...
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...obesity, Ms. C has several skin folds throughout her body, which make a great medium for fungal infections. The area underneath her skin folds is red and irritated. Ms. C has had oliguria for the past several days and is outputting very little to no urine. A foley catheter has been placed in order to remove any urinary retention. However, very minimal urine seems to be coming out of foley. The doctors have requested labs to be drawn on a regular basis to check her kidney function and to also monitor her electrolytes. Her admitting diagnosis is Acute Renal Failure. Past Medical History: o Essential Hypertension o Hyperlipidemia o Diabetes Mellitus Type 2 o Stage 3 Diabetic Chronic Kidney Disease o Severe Obesity Present Medical History: o Severe abdominal pain o Dehydration o Oliguria o Uncontrolled Diabetes o Chronic Kidney Disease o Hypertension o Obesity Active Orders: o Foley Catheter o Oxygen 2 L NC o Blood Sugar Monitoring AC and HS o Insulin Regular o Insulin NPH 10 units in AM o Insulin NPH 5 units before bed time o Flucanozole 100 mg IV o D5W 1000 mL with Sodium Bicarb 100 mEq IV solution running at 75 ml/hr o Albuterol 2.5 mg/0.5 mL Nebulizer 2.5 mg o Morphine Inj Syg 2mg PRN Q4H o Morphine Inj Syg 4 mg PRN Q4H o Lotrimin Cream o Ondansetron inj 4mg o Levothyroxine tab 175 mcg o Acetaminophen 650 mg o D50W Inj Syg o Glucagon Inj 1 mg o QVAR 80 o Famotidine 20 mg o Albuterol o Lasix...
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...blood to drop as well. A drop in albumin will cause a drop in blood volume in the blood vessels. The kidneys will sense this drop in blood volume and begin to retain salt. Fluid will then start to move into the interstitial spaces in the body, thus causing Mr. H. to become swollen. Another cause of the edema may be due to impaired kidney function and they can’t effectively excrete sodium into the urine. If Mr. H. is ingesting more sodium than he can get rid of, his body will hold on to that can cause him to have salt retention. Mr. H. has experienced weight gain due to all this extra fluid that his body has begun to retain (Cunha, 2008). 3) Mr. H. has most likely been experiencing fatigue due to low hemoglobin and hematocrit levels, hypertension and edema. Having low hemoglobin and hematocrit will lead to...
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