NURSING MANAGEMENT OF

PATIENTS WITH CARDIOVASCULAR

DISORDERS

01/21/2025 SAMUEL K
 Coronary Artery Disease (CAD)
 CAD is a condition in which there is an inadequate supply

of blood and oxygen to a portion of the myocardium

Coronary Atherosclerosis

Arteriosclerosis is thickening or hardening of arteries

Atherosclerosis is a type of arteriosclerosis caused by a

build-up of plaque (fatty substances, cholesterol, cellular
wastes, calcium, fibrin) in the inner lining of an artery.

01/21/2025 SAMUEL K
 CAD …

Coronary Atherosclerosis: blocks or

narrows lumen of coronary artery
resulting in reduced blood flow to the
myocardium.
The nature of coronary arteries makes it
risky for atherosclerosis
Atherosclerosis is the major cause of CAD

01/21/2025 SAMUEL K
SAMUEL K 01/21/2025
 CAD …

Risk factors:
Modifiable Risk factors
Non modifiable
Major:
Family history of
High blood cholesterol
CAD
Hypertension
Gender
Cigarette smoking
Increasing age
Physical inactivity
Race
01/21/2025 SAMUEL K
 CAD …
Minor
Obesity
DM
Stressful life style
Postmenopausal estrogen deficiency
High saturated fat intake etc

The risk of CAD is associated with:

A serum cholesterol level of >200mg/dL

A fasting triglyceride level of >150mg/dl

01/21/2025 SAMUEL K
 CAD …
Clinical Manifestations

S/S and complications depend on:

Location and degree of narrowing of the

arterial lumen

Thrombus formation

Obstruction of blood flow to the myocardium

 heart attack or sudden cardiac

death
01/21/2025 SAMUEL K
 CAD…

Prevention

Control of the following four modifiable

risk factors:

Increased Cholesterol

Cigarette Smoking

Hypertension

DM
01/21/2025 SAMUEL K
Management/Treatment

Many people are able to manage

coronary artery disease with lifestyle
changes and medications.
Other people with severe coronary
artery disease may need angioplasty or
surgery.

SAMUEL K 01/21/2025
 CAD…
Management…

Referring to registered dietitian for

dietary measures

Weight reduction

Increased physical activity

Promoting cessation of tobacco use

Early detection and treatment of
hypertension
01/21/2025
Controlling DM SAMUEL
insulin
K
& metformin
 CAD…

Medications to decrease LDL, triglycerides & increase

HDL
Lovastatin
Prevastatin
Simvastatin
Fluvastatin
Atrovastatin

01/21/2025 SAMUEL K
 CAD …

Nicotinic acid
Niacin: Decreased blood lipids
Fibric acids: primarily inhibits triglyceride
synthesis.
Fenofibrate
Colofibrate

01/21/2025 SAMUEL K
 Surgical intervention
1.Stenting: stent is introduced into blood vessel
on balloon catheter & advanced into the blocked
area

 The balloon is then inflated and causes the stent

to expand until it fits the inner wall of the vessel

 The stent stays in place permanently, holding the

vessel open and improving the flow of blood.

SAMUEL K 01/21/2025
 Stent

Stent is a tube placed in the coronary arteries to keep it open (to treat CAD)
SAMUEL K 01/21/2025
 Treatment cont’d…
2. Angioplasty
A balloon catheter is passed through the guiding catheter
to the area near the narrowing. A guide wire inside the
balloon catheter is then advanced through the artery until
the tip is beyond the narrowing.

Balloon is inflated, compressing the plaque against the

artery wall

 Once plaque has been compressed and the artery has been
sufficiently opened, the balloon catheter will be deflated
and removed. SAMUEL K 01/21/2025
Angioplasty…

SAMUEL K 01/21/2025
3. Bypass surgery Treatment cont’d…

 Healthy blood vessel is removed from

leg, arm or chest and used to create new
blood flow path in the heart

 The “bypass graft” enables blood to

reach the heart by flowing around
(bypassing) the blocked portion of the
diseased artery.

 The increased blood flow reduces angina

SAMUEL K 01/21/2025
 Angina pectoris
Angina pectoris is a clinical syndrome usually characterized
by episodes/paroxysm of pain or pressure in the anterior
chest.

Cause:

Insufficient coronary blood flow which results in a

decreased oxygen supply to meet an increased myocardial
demand in response to physical exertion or emotional stress.

Usually caused by atherosclerosis

01/21/2025 SAMUEL K
 Clinical manifestation
Pain
 vary from feeling of indigestion to chocking
 Retrosternal area, radiate to neck, jaw, shoulders, inner aspects of upper arms, upper
abdomen
 5–15 min, myocardial ischemia, due to coronary atherosclerosis
 Pressing, squeezing, tight, heavy, burning

Weakness or numbness in the arms, wrists and the hands

Shortness of breath
Pallor, Diaphoresis
Dizziness or lightheadedness
Nausea and vomiting
• Weak relationship between severity of pain and degree of oxygen supply

01/21/2025 SAMUEL K
01/21/2025 SAMUEL K
 Types of angina pectories
Stable angina

Unstable angina

Prinzmetal’s angina/variant angina

01/21/2025 SAMUEL K
Stable angina:
Also called “Effort Angina”

Pain/discomfort is precipitated by activity

Minimal or no symptoms at rest

Symptoms disappear after rest/cessation of activity and

when stress is reduced.

01/21/2025 SAMUEL K
Unstable angina:
Also called “Crescendo angina” - pain increases every time

Symptoms occur more frequently and last longer than stable

angina

Acute coronary syndrome in which angina worsens

Pain may occur at rest because the threshold is lower

Severe and of acute onset

01/21/2025 SAMUEL K
 Prinzmetal’s/variant angina
Prinzmetal’s angina is a variant form of angina with normal
coronary vessels or minimal atherosclerosis

It is probably caused by spasm of coronary artery

01/21/2025 SAMUEL K
 Diagnosis
 History and physical examination

ECG (12-lead)

Echocardiogram

Blood test

C-reactive protein ( CRP)

Invasive procedures (cardiac catheterization and

coronary artery angiography)
01/21/2025 SAMUEL K
 Treatment:

Aims:

Relief of symptoms

Slowing progression of the disease

Reduction of future events like myocardial

infarction

01/21/2025 SAMUEL K
 Medical Management
For treatment of acute attacks:
 Organic nitrates/nitrites: nitroglycerin
 Oxygen administration

Prophylaxis:
 Organic nitrates
 Beta blockers: Propanolol, Metroprolol, Atenolol
 Calcium channel blockers: Amilodipine, Diltiazem
 K+ channel opener- Nicorandil
 Antiplatelet agents: Asiprin, heparin, clopidogel and ticlopidine

01/21/2025 SAMUEL K
 Nursing Diagnosis
Ineffective cardiac tissue perfusion secondary to CAD as
evidenced by chest pain and symptom

Anxiety related to fear of death

Pain related to disease process

 Noncompliance, ineffective management of therapeutic

regimen related to failure to accept necessary lifestyle
changes

 Deficient knowledge about the underlying disease and

methods for avoiding complications
01/21/2025 SAMUEL K
 Nursing Intervention
Oxygen administration

Relieving anxiety

Relieving pain

Encourage rest

Avoid precipitating factors

01/21/2025 SAMUEL K
Myocardial Infarction (MI)

 MI refers to the process by which areas

of myocardial cells in the heart are
permanently destroyed.
 As the cells are deprived of oxygen,
ischemia develops, cellular injury
occurs, and over time, the lack of
oxygen results in infarction, or cell
death. SAMUEL K 01/21/2025
 MI..

Causes
 Reduced blood flow in a coronary arteries due to:
Thrombus (80-90% Cases)
Vasospasm
Atherosclerosis
 Decreased O2 supply

 Increased O2 demand

 In each case, imbalance exists b/n myocardial O2 demand

& supply
01/21/2025 SAMUEL K
 Risk factors

 Advanced age

 Gender (men)

 Diabetes mellitus, Obesity (BMI >30 kg/m²)

 High blood pressure, Lack of physical activity

 Dyslipidemia/hypercholesterolemia - high LDL, low HDL

 Tobacco smoking, Alcohol, + smoking

 Air pollution: CO, N2O,

 Family history of ischaemic heart disease or MI

01/21/2025 SAMUEL K
Myocardial Infarction

SAMUEL K 01/21/2025
 C/M
 Pain,SOB, dyspnea, tachypnea, crackles, pulmonary edema

 Nausea & Vomiting

 Cool, clammy, diaphoretic, and pale appearance

 Peripheral vasoconstriction

 Tachycardia, bradycardia, and dysrhythmias.

 Fever

 Headache, visual disturbances, altered speech, altered

motor function, and further changes in LOC
SAMUEL K 01/21/2025
 Other s/s …

Discomfort, palpitations.

S3, S4, and new onset of a murmur.

Increased jugular venous distention

Blood pressure changes.

01/21/2025 SAMUEL K
MI…

Diagnosis
HX
Physical Examination
Lab tests e.g. – Increased
myoglobin
Cardiac biomarkers: Troponin level
ECG changes
Echocardiogram
SAMUEL K 01/21/2025
 MI…

Medical Mgt

Goals:-

• Minimizing myocardial damage

• Preserving myocardial function

• Preventing complications

01/21/2025 SAMUEL K
 MI…

Pharmacologic therapy

Thrombolytics e.g. streptokinase

Analgesics e.g. morphine sulphate & meperidine

ACE inhibitors e.g. captopril

Antidysrhythmic drugs

B- blockers, Calcium channel blockers

01/21/2025 SAMUEL K
 Nursing Diagnoses
Pain related to poor O2 supply to the
myocardium
Risk for impaired gas exchange related to fluid
overload from left ventricular dysfunction
Risk for altered peripheral tissue perfusion
related to decreased CO from left ventricular
dysfunction
Anxiety related to fear of death

Deficient knowledge about post-MI self-care

01/21/2025 SAMUEL K
 MI…

Nursing Interventions

Relieving pain
– Oxygen administration

– Morphine & thrombolytics administration as prescribed

– Monitoring V/S every 1-2 hrs

– Physical rest in bed with backrest elevated

01/21/2025 SAMUEL K
01/21/2025 SAMUEL K
Acute Rheumatic Fever (ARF) and
Rheumatic Heart Disease (RHD)
 RF is an inflammatory disease of the
joint and heart potentially involving all
the layers of the heart.

 The resulting damage to the heart

from RF is called rheumatic heart
disease, a chronic condition
characterized SAMUEL
by Kscaring and deformity
01/21/2025
 Rheumatic Heart Disease…

Rheumatic heart disease affects the heart

valves.

As blood flows, bacteria can infect the

heart valves

Mitral and aortic valves are most

commonly affected by the rheumatic
endocarditis, less commonly tricuspid
valve
01/21/2025 SAMUEL K
Rheumatic Heart Disease…

Etiology and Epidemiology

 ARF occurs most often in school age children (5-

15yrs) following group A- beta hemolytic
streptococcal pharyngitis

 Spread/transmission contact with oral or

respiratory secretions

SAMUEL K 01/21/2025
Clinical Manifestations

 Fever
 Arthritis
Joint pain, swelling, redness and warmth
 Skin rash (erythematic mariginatum)
 Skin nodules
 Sydenham’s chorea
 Nose bleeds
 SOB, chest pain,
 Murmur, cardiomegally
SAMUEL K 01/21/2025
 Clinical Manifestations…

Skin nodules

SAMUEL K 01/21/2025
Arthritis

 Most common feature: present in 80% of

patients
 Painful, migratory, short duration,
excellent response for salicylates
 Usually >5 joints affected and large joints
preferred
Knees
Ankles
Wrists
Elbows
Shoulders SAMUEL K 01/21/2025
Carditis
 Most serious manifestation which affect any
cardiac tissue
 May lead to death in acute phase or at later
stage
 Clinical signs:
 High pulse rate/heart beat
 Murmurs
 Cardiomegaly
 Rhythm disturbances
 Pericardial friction rubs
 Cardiac failure
 SOB, persistent cough, chest pain,
tiredness
 Mitral and aortic regurgitation
SAMUEL K most common
01/21/2025
Diagnosis

 History

 Physical Exam

 Lab tests

 ECG

 Chest X-ray

 Synovial fluid analysis

SAMUEL K 01/21/2025
 Jones Criteria for the diagnosis of ARF
Two major or
One major and two minor
Major criteria
Minor criteria
Carditis
Fever
Polyarthritis
Previous occurrence of
Chorea RF or RHD
Erythematic Arthralgia
mariginatum
Prolonged PR interval
Subcutaneous nodules
Lab findings
01/21/2025 SAMUEL K
Medical Mgt
Objectives
Eradicating causative organisms
Preventing additional complications
Pharmacologic therapy includes:
Long term antibiotic treatment
ASA
Corticosteroids

SAMUEL K 01/21/2025
Nursing Mgt
Patient education about

 The disease, Its treatment

 The preventive steps needed to avoid potential

complications

**Antibiotics administration before invasive

procedures

SAMUEL K 01/21/2025
Infective Endocarditis

It is an infection of the valves and endothelial surface

of the heart
Causes
Bacteria
Streptococci (60%)
Staphylococci (20%)

Rickettsiae
Fungi
Chlamydia

SAMUEL K 01/21/2025
 Clinical Manifestations
 Fever
 Chills, anorexia, weight loss
 Arthralgias, myalgias, back pain, weakness, malaise, fatigue
 Clubbing of fingers
 Splinter hemorrhages occur in nail beds
 Petechiae in conjuctiva & mucus membranes

SAMUEL K 01/21/2025
Clinical Manifestations …
Abnormal urine color, Blood in the urine

Excessive sweating (Night sweats)

Shortness of breath with activity

Swelling of feet, legs, abdomen

Bleeding in the retina (Roth's spots)

01/21/2025 SAMUEL K
Petechiae

1. Nonspecific
2. Often located on extremities or mucous membranes

SAMUEL K 01/21/2025
Janeway Lesions

1. More specific
2. Nonpainful Erythematous, blanching
macules
3. Located on palms and soles
SAMUEL K 01/21/2025
Diagnosis

 History
 Physical examination
 Blood culture (positive in 90-95% of patients

 Chest X-ray
 ECG
 Echocardiography

 Increased WBCs

SAMUEL K 01/21/2025
Medical Mgt

 Appropriate parenteral antibiotics for 2-6 wks

Eg. vancomycin and ceftriaxone, pencillin, ciprofloxacilin or
gentamycin, Flucloxacilin

 Antifungal agents like amphotericin- if fungal endocarditis

 Antipyretics: PCM
Surgical Mgt

Surgical valve repair or replacement for sever valve case

Prevention

 Antibiotics prophylaxis before and after dental, oral, respiratory,

urinary or esophageal procedures


SAMUEL K 01/21/2025
Continued medical follow-up
Nursing Management

 Monitoring
Body temp
S/S of systemic embolization
S/S of pulmonary infarction & infiltrates
 Assess for S/S of organ damage such as
stroke, HF, MI, meningitis,
glomerulonephritis & spleenomegally

 Pre & post –op care if the patient received

surgical treatment
SAMUEL K 01/21/2025
 Nursing Management…

 Bed rest
 Teach the family and patient about:
Any activity restriction, medications & s/s of
infection
Need of prophylactic antibiotics before and
after dental, respiratory, GI & GU procedures

 Provide emotional support

01/21/2025 SAMUEL K
 Potential Complications

Blood clots or emboli to brain, kidneys,

lungs, etc
Brain abscess, Stroke
Congestive heart failure
Glomerulonephritis
Dysrhythemias
Severe valve damage

01/21/2025 SAMUEL K
SAMUEL K 01/21/2025
Heart failure (HF)

 HF, often referred to as congestive HF

(CHF), is the inability of the heart to
pump sufficient blood to meet the needs
of the tissues for oxygen and nutrients

 It is a problem with contraction (systolic

dysfunction) or filling of the heart (diastolic
dysfunction) and may or may not cause pulmonary
or systemic congestion
SAMUEL K 01/21/2025
Classification of HF
Systolic Vs Diastolic dysfunction

 Systolic Dysfunction: the ventricle is unable to

contract forcefully enough during systole

 Diastolic dysfunction: the left ventricle is unable

to relax adequately during diastole

Based on the side of the heart involved

 Left heart failure

 Right heart failure

SAMUEL K 01/21/2025
Left heart failure

 LHF results from LV dysfunction,

 Cause Increased Pulmonary pressure

 Fluid extravagation from the pulmonary
capillary bed into the interstitial spaces & the
alveoli

 Pulmonary congestion & Edema occurs

SAMUEL K 01/21/2025
II. Right sided failure

 RHF results from a diseased RV that causes back

ward flow of blood to the RA and venous
circulation.

Causes
 Left ventricular failure (the usual cause)

 CAD e.g. RV MI

 Pulmonary hypertension

SAMUEL K 01/21/2025
Common causes of CHF

 CAD Compensatory
 Cardiomyopathy mechanisms for ed CO:

 Systemic or pulmonary Increased HR

hypertension Improved stroke Volume

 Valvular heart disease Arterial

vasoconstriction
 ed CO (anemia,
Sodium & water
hypoxia)
retention
 Rheumatic heart
Myocardial hypertrophy
disease SAMUEL K 01/21/2025
 Clinical Manifestations
Left sided HF
Decreased CO
 Dizziness
 Fatigue,
 Tachycardia, palpitation
 Decreased activity
tolerance  Apical impulse

 Oliguria during the displacement

day  Pallor

 Nocturia  Cyanosis

 Angina  Weak peripheral pulse

 Confusion,  Cool extremities at rest
01/21/2025 restlessness SAMUEL K
C/M LHF cont’d…

Pulmonary congestion
 Cough -hacking, worsen at night
 Dyspnea, orthopnea, paroxysmal nocturnal
dyspnea (cardiac asthma)
 Crackles/rales or wheezes in lungs
 Tachypnea

SAMUEL K 01/21/2025
C/Ms Right sided HF
Systemic Congestion

 Jugular vein distension (JVD)

 Hepatomegally & spleenomegally

 Anorexia, nausea

 Dependent edema -legs & sacrum

 Ascites
 Nocturia
 Weight gain

 Change in PB SAMUEL K 01/21/2025

C/Ms Cont’d…

SAMUEL K 01/21/2025
Medical Mgt

Objectives

 To eliminate or reduce etiologic or

contributing factors

 To reduce the workload on the heart by

reducing after load & preload

SAMUEL K 01/21/2025
Nutritional therapy
Low sodium diet (< 2g -3g /day)

Avoid excessive fluid intake

SAMUEL K 01/21/2025
Pharmacologic Therapy

ACE - inhibitors (ACE-Is)

 Promotes vasodilatation & diuresis
 Include:
 Captopril
 Enalapril
 Lisinopril
Angiotensin II receptor blockers (ARBs): Losartan
 Decreases BP & systemic vascular resistance
Hydralazine
 Decreases systemic vascular resistance
Beta blockers e.g. Propranolol

SAMUEL K 01/21/2025
Pharmacologic Therapy Cont’d…
Digitalis e.g. digoxin
 Increases the force of myocardial contraction &
slow conduction through the AV node

Diuretics
 Thiazides e.g. Chlorothiazide, hydrochlorothiazide
 Loop diuretics e.g. furosemide (lasix)
 Potassium sparing e.g. spironolactone
 Combination agents e.g. spironolactone +
hydrochlorothiazide

Other medications
 Anticoagulants
 Antianginal medications
SAMUEL K 01/21/2025
 NURSING DIAGNOSES
Activity intolerance related to imbalance between oxygen supply
and demand because of decreased CO

Excess fluid volume related to excess fluid or sodium intake and

retention of fluid because of HF and its medical therapy

Risk for impaired skin integrity related to edema

Anxiety related to breathlessness and restlessness from

inadequate oxygenation

Powerlessness related to inability to perform role responsibilities

because of chronic illness and hospitalizations

Noncompliance related to lack of knowledge

01/21/2025 SAMUEL K
 INTERVENTIONS OF PATIENTS WITH
VASCULAR DISORDERS

01/21/2025 SAMUEL K
 BP Regulation Involves:
1. Nervous System Regulation

I. Autonomic Nervous System

II. Baroreceptors (pressero receptors)

2. Renal System

3. Endocrine system

 Defect in one of the regulating mechanisms may

result in HTN
01/21/2025 SAMUEL K
 Hypertension
Hypertension-is defined as:
systolic BP (SBP) > 140 mmHg and
diastolic BP (DBP) > 90mmHg
based on the average of two or more

correct BP measurements taken during

two or more contacts with the health care
provider

01/21/2025 SAMUEL K
 Category Systolic BP Diastolic
(mmHg) BP (mmHg)
Normal <120 And <80

Pre-hypertension 120-139 Or 80-89

Stage 1 or Mild 140-159 Or 90-99

HTN
Stage 2/Moderate 160-179 Or 100-109
HTN
Stage 3 Sever HTN > 180 Or > 110

01/21/2025 SAMUEL K
 Etiology of Hypertension
Can be primary (essential) or secondary
hypertension
I. Primary (Essential) hypertension
Accounts for 90-95% of all cases
Has no known causes
Onset usually between the age of 30 & 50yrs
Associated risk factors include:
 Advanced age
 Family history
 Obesity
 High sodium intake
 Cigarette smoking
 Sedentary lifestyle
 Excessive alcohol in take
 Diabetes
 Stress and increased serum lipid level
01/21/2025 SAMUEL K
 II. Secondary hypertension
 Has specific cause

 Accounts for <5-10% of cases

 Brain tumors
 Identifiable causes include:
 Pregnancy
 Coarctation or congenital
abnormalities of aorta
 Medications:

 Renal disease Estrogen

 Renovascular HTN Glucocorticoids
 Pheochromocytoma Sympathomimetics (e.g.
 Cushing’s syndrome dopamine, dobutamine)
01/21/2025 SAMUEL K
 Clinical manifestations

HTN is often called “silent killer”

With severe hypertension symptoms

developed secondary to effect on blood
vessels in various organs and tissues or
to increased work load of the heart

01/21/2025 SAMUEL K
 These C/Ms may include:

 Headache
 Nocturia  Blurring of vision
 Increased BUN & creatinine  Epistaxis
 Speech & vision alternation  Occasionally, retinal
 Dizziness changes

 Weakness Hemorrhages
Exudates
 Faintness (sudden fall)
small infarction
 Sudden hemiplegia

01/21/2025 SAMUEL K
 Hypertensive crises

Present as hypertensive urgency or hypertensive

emergency
Systolic reading of 180mmHg or higher OR
diastolic reading of 110mmHG or higher, on two
separate occasions at minutes interval
Needs immediate emergency medical treatment

01/21/2025 SAMUEL K
 Hypertensive Urgency

There is no associated organ damage.

Patients may or may not experience one or more of

these symptoms:
 Severe headache,

 Shortness of breath,

 Nosebleeds, and

 Severe anxiety.

Treatment requires readjustment and/or additional

dosing of oral medications, without hospitalization
01/21/2025 SAMUEL K
 Hypertensive emergency "malignant
HTN’’)
• Is hypertension with acute impairment of one or more organ
systems that can result in irreversible organ damage.

• It generally occurs at blood pressure levels exceeding 180

systolic OR 120 diastolic, but can occur at even lower levels
in patients whose blood pressure had not been previously
high.

01/21/2025 SAMUEL K
 Manifestations

Eye: retinal hemorrhage or exudate, Papilloedema

Brain: s/s of IICP: headache, vomiting, and/or subarachnoid

or cerebral hemorrhage.

Kidney: hematuria, proteinuria and acute renal failure

• Heart: left ventricular dysfunction.

Other s/s can include:

• Chest pain, Arrhythmias, Epistaxis, Dyspnea, Faintness or

vertigo, Severe anxiety, Altered mental status, Paresthesia

01/21/2025 SAMUEL K
 Medical Management
Goals

 Preventing death and complications

 Achieving and maintaining the arterial BP at:
 140/90 mmHg or lower
 <130/80 mmHg for people with DM & chronic kidney diseases

The managements of hypertension include:

Lifestyle modifications
Pharmacologic therapy
01/21/2025 SAMUEL K
 Management…

Indications of Life style modification:

 Person with either border line or sustained HTN
Lifestyle modifications
Weight reduction

Moderation of alcohol intake

Regular physical activity

Reduction of sodium intake

Smoking cessation
Dietary management (reduce salt, calories, cholesterol, and saturated fats;
sufficient intake of potassium, magnesium, calcium, and vitamin C)
01/21/2025 SAMUEL K
 Medical Management…

Indications of drug therapy:

 BP remaining > 140/90mmHg after 3-6 months
of life style changes
 Presence of target organ damage

 Presence of other complications or risk factors

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 Drugs used for the treatment of HTN
include:

Vasodilating drugs: Hydralazine

β-adrenergic blocking drugs
Atenolol, Metoprolol, Propranolol
Antiadrenergic drugs (centrally
acting)
Methyldopa
Alpha (α)-adrenergic blocking
drugs
Doxazosin, Prazosin
01/21/2025 SAMUEL K
 Drugs …
Calcium channel blockers
Nifidipine, Verapamil, Diltiazem
Angiotensin-converting enzyme (ACE)
inhibitors
Captopril, Enalapril, Lisinopril
Angiotensin II receptor antagonists
Losartan, Valsartan, Irbesartan
Diuretics
Furosemide (Lasix)
Spironolactone
Hydrochlorothiazide
01/21/2025 SAMUEL K
 Nursing Interventions

1. Improving activity tolerance

2. Alleviating pain (headache)

3. Advice about adherence to treatment

4. Nutritional advice

5. Avoiding potential complications

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 RBC Disorders

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 Anemia

Anemia is a qualitative or quantitative deficiency of

hemoglobin, in red blood cells that transports oxygen.

It is a lower than normal number of red blood cells,

usually measured by a decrease in the amount of
hemoglobin.

Is the most common disorder of blood which leads to

hypoxia in organs.

Not specific disease but a sign of underlying disorder.

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 Classification

Anemia can be classified in a variety of

ways, based on:
Production vs destruction or loss

The morphology of RBCs

Underlying etiologic causes

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 Potential causes

1. Loss of RBCs—bleeding, (eg. GIT, uterus, nose, or wound)

2. Decreased production of RBCs (ineffective hematopoiesis

): deficiency in cofactors for erythropoiesis; bone marrow
suppression or lack of erythropoietin.

3. Hemolysis: overactive RES (e.g. hypersplenism) or

production of abnormal RBCs (eg, sickle cell anemia)

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 Causes & risk Factors

Blood loss, nutritional deficits, diseases, medication, and

problems with the bone marrow,

Heavy menstrual periods

 Pregnancy
Older age

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 Clinical Manifestations
Several factors influence anemia-associated symptoms:

• The speed with which the anemia has developed

• The duration of the anemia (ie, its chronicity)

• The metabolic requirements of the individual

• Other concurrent disorders or disabilities

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 Types and potential causes
Vit-B12 deficiency Anemia
Folate deficiency Anemia Pernicious anemia
Iron deficiency Anemia
Anemia due to chronic disease
Hemolytic anemia like Sickle cell anemia
Aplastic anemia
Idiopathic anemia

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01/21/2025 SAMUEL K
 Treatments for anemia

Treatment depends on severity and the cause.

Treatment goals:
 to get RBC counts or Hgb levels back to normal

 to treat the underlying cause of the anemia

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 Shock

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 Shock
Shock is a serious, life-threatening medical
condition where insufficient blood flow reaches the
body tissues.

Reduced blood flow hinders oxygen and nutrients

delivery to the tissues, and can stop the tissues
from functioning properly.

It is a medical emergency and one of the most

common causes of death for critically-ill people.
01/21/2025 SAMUEL K
 Stages of shock

• There are four stages of shock, although

shock is a complex and continuous
condition
• Initial stages

• Compensatory (Compensating)

• Progressive (Decompensating)

• Refractory (Irreversable)

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 Initial stage

• Changes attributed to this stage occur at

the cellular level and not detectable
clinically.

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 Compensatory Stage

Blood pressure remains within normal limits.

Vasoconstriction, increased HR and contractility

to maintain adequate cardiac output (SNS)

The patient displays the “fight or flight”

response.

The body shunts blood to the brain and heart

Skin is cold and clammy, bowel sounds are

hypoactive, and urine output decreases

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 Hypovolemic shock

This is the most common type of shock and is caused by

insufficient circulating volume.

Cause and risk factors

Internal: Fluid Shifts
External: Fluid Losses
Hemorrhage
 Trauma
Severe Burns
 Surgery
Ascites
 Vomiting
Dehydration
 Diarrhea

01/21/2025  Diuresis SAMUEL K

 Cardiogenic shock
This type of shock is caused by the failure of the heart to
pump effectively.

Cause
Myocardial infarction

Arrhythmias

Cardiomyopathy

Congestive heart failure (CHF)

Cardiac valve problems

01/21/2025 SAMUEL K
Cont…..
A. Septic shock: is a type of shock caused by infection

Cause

Infections leading to vasodilatation caused by:

– Gram negative bacteria i.e. E.coli, Proteus species,

– Gram-positive cocci, such as streptococci

– Certain fungi
May be related to:
◦ Immunosuppression, Extremes of age, Malnourishment, Chronic illness, Invasive procedures

01/21/2025 SAMUEL K
 Treatment of shock

In the early stages, shock requires immediate

intervention to preserve life, even before a
diagnosis is made.

Re-establishing perfusion to the organs is the

primary goal through restoring and maintaining the
circulating blood volume to effective cardiac
function, and preventing complications.

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 Nursing intervention
• Maintain fluid volume at a functional level.

• Monitor vital signs (blood pressure, temperature,

and pulse)

• Maintain elastic skin turgor, most tongue and

mucous membranes, and orientation to person,
place, and time.

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 DISEASES OF THE RENAL SYSTEM

URINARY TRACT INFECTION (UTI) IN CHILDREN

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 objectives

At the end of this portion, the students will be able to;

• List and define urinary tract infections in children
• Explain the clinical manifestations of UTIs
• Define and discuss idiopathic nephrotic syndrome, its manifestations and
management.
• Explain renal failure

01/21/2025 SAMUEL K
 cont.
• UTI refers to a group of conditions in which there is
growth of bacteria within the urinary tract.
• The etiologic agents in UTI are mainly colonic bacteria.
• E.coli, klebsiella, staphylococus saprophyticus and
proteus are among the commonest causes.
• E.coli causes 75-90% of UTIs in females.
•

01/21/2025 SAMUEL K
 cont.

Classification of UTI There are three forms of UTI;

asymptomatic bacteriuria
Cystitis and
pyelonephritis

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 cont.

Asymptomatic bacteriuria:
 This is a benign condition
 characterized as presence of positive urine culture without any manifestations
of infection
 occurs almost exclusive in females

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 cont.

Cystitis: inflammation of the bladder as a result of infection of the urinary

bladder.
C/M
dysuria, urgency, frequency, suprapubic pain, incontinence and
malodorous urine.
Cystitis does not result in renal injury.

01/21/2025 SAMUEL K
 cont.

pyelonephritis : inflammation of renal parenchyma and it may result

in renal injury called pyelonephritis renal scarring.
C/M
• abdominal or flank pain
• malaise
• fever
• nausea, vomiting, and occasionally diarrhea
01/21/2025 SAMUEL K
diagnosis
• Clean catch
• Urethral catheterization
• Suprapubic needle aspiration
• Urine analysis
• Urine culture
• ultrasound

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Management
• Antibiotics like amoxicilin(high dose) 125mg/5ml, 250mg/5ml tid for
7 days, Amoxicillin/clavulanate (Augmentin)25 to 45 mg per kg per
day BID, Trimethoprim/sulfamethoxazole (Bactrim) 8 to 10 mg per kg
per day, divided every 12 hours.

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NURSING MANAGEMENT
• Nursing Assessment and Diagnoses
• Nursing assessment focuses on identifying S/S of
urinary tract infections and related complications.

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Mgt…
• An early morning urine specimen is preferred because the urine is
more concentrated.
• The early morning specimen may be used for repeat cultures, but in
order to facilitate identification of a UTI and initiation of therapy, do
not delay in obtaining the urine specimen.

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Nsg mgt…
• Psychosocial Assessment: Sexually active

adolescents may deny having symptoms because they

fear disclosing their sexual activity to their parents.

• useful questioning may be necessary to elicit a

response despite these concerns.

• Be open and approachable, and give the patient and

01/21/2025 family the chance to address

SAMUEL K their concerns.
Acute glomerulonephritis (AGN)
• AGN is glomerular injury due inflammation of the glomeruli of the
kidney Interference with the glomeruli filtering waste products from
the blood.
• If the inflammation follows the course of an infection it is called
postinfectious glomerulonephritis (PGN).
• Ag-Ab complexes with the streptococcal bacteria form and are
deposited in the glomeruli w/c altered glomerular structure and
function in in both kidneys causing damage

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Clinical manifestations…
• Classical symptoms: hypertension, hematuria, Edema, and oliguria
(severely reduced volume).
• Constitutional symptoms: Loss of appetite, malaise, lethargy,
abdominal or flank pain, a lowgrade fever, vomiting, or headache.
• Urine: Cloudy, smoky brown (resembles tea or cola

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Treatment
• There is no specific therapy for APSGN.
• Mgt is directed at treating the acute effects of renal insufficiency and
HTN
• Bed rest is not necessary
• Regular measurement of vital signs, body wt, and intake and output
are essential

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Nephrotic syndrome
• Nephrotic syndrome does not refer to a specific disease, but rather to a
clinical state characterized by edema, massive proteinuria,
hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered
immunity.

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• is primarily a pediatric disorder and is 15 times more common in
children than adults.
• the majority of affected children will have steroid-sensitive minimal
change disease

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Idiopathic Nephrotic Syndrome

• Most common form of nephrotic syndrome is idiopathic.

• <10% is secondary to glomerular diseases such as membranous
nephropathy or membranoproliferative glomerulonephritis

01/21/2025 SAMUEL K
 cont.

Clinical Manifestations
• Attacks may follow URTI
• It usually presents with pitting edema, initially noted in periorbital area and in
the lower extremities.
• The edema becomes generalized with time.

01/21/2025 SAMUEL K
 cont.

• Some patient present with hypotension secondary to significant shift of fluid

from intravascular to third space.
• With massive pleural effusion and ascites, patients may develop dyspnea.
• gross hematuria and hypertension are uncommon

01/21/2025 SAMUEL K
 Diagnosis
• Diagnosis is based on the history, characteristic
symptoms, and laboratory findings.
• Urinalysis as well as serum albumin, sodium, BUN,
cholesterol, and electrolytes ore ordered.
• Urinalysis reveals proteinuria (+3or +4 on dipstick).

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 Complications

• Infection is the major complication of nephrosis.

Contributing factors include
 hypogammaglobulinemia
decreased bactericidal activity of leukocytes and
 edema fluid acting as a culture medium

01/21/2025 SAMUEL K
 Treatment
General measures
• patients with mild to moderate edema can be managed as
outpatients.
• Salt should be restricted (until the edema resolves)
• Diuretics can be used cautiously to reduce the edema.
• In mild cases, chlorothiazide or spironolactone can be used

01/21/2025 SAMUEL K
 cont.

• in severe cases with respiratory distress to ;

massive pleural effusion and ascites or
 severe scrotal edema frusemide (P.O, or IV with poor response to P.O
treatment) can be administered with careful monitoring of renal function and
serum electrolytes.

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 Steroids

• More than 95% of patients with idiopathic NSrespond to steroids.

• In children with presumed minimal change disease prednisolone should be
administered in a dose of 1-2mg/kg/24hr (maximum 80 mg/d) in 3 to 4 divided
dose for 4 to 6 weeks.

01/21/2025 SAMUEL K
NURSING MANAGEMENT

• Nursing Assessment and Diagnoses: focuses on signs of fluid volume

excess, complications related to the disorder, and the psychosocial
impact of the condition on the child and family.

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Acute Renal Failure (ARF)

• Acute renal failure (ARF) is a clinical syndrome in which a sudden

deterioration in renal function results in inability of the kidneys to maintain
fluid and electrolyte homeostasis.
• ARF is a result of decreased perfusion to an otherwise normal kidney In
association with a systemic condition.

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 Definition
AKI is defined as any of the following:
• Increase is SCr by > 0.3 mg/dl within 48 hrs or
• Increase in SCr to > 1.5 times baseline within the
past 7 days or
• Urine volume < 0.5 ml/kg/h for 6 hrs

01/21/2025 SAMUEL K 145

01/21/2025 SAMUEL K 146
Etiology of ARF
• Pre renal Etiology: oliguria due to inadequate perfusion of the kidneys
• Renal Etiology: renal parenchymal cell injury or disease
• Post renal Etiology: results from mechanical obstruction to urine flow

01/21/2025 SAMUEL K 147

 cont.

a) Prerenal causes
• Hemorrhage
• Dehydration
• Sepsis
• Cardiac failure and others

01/21/2025 SAMUEL K
 cont.

b) Intrinsic renal causes

• Glomerulonephritis, such as rapidly progressive GN
• Acute tubular necrosis (ATN)
• Acute interstitial nephritis

01/21/2025 SAMUEL K
 cont.

c) Post renal causes

• Only bilateral obstruction leads to ARF
Etiology :
1. Internal ureteral or bladder obstruction
2. External compression: abdominal mass
3. Bladder paralysis: spinal cord injury
4. Neurogenic bladder dysfunction
5. Vesico-uretheral reflux

01/21/2025 SAMUEL K
 Diagnosis

• detecting elevated bun (blood urea nitrogen) and creatinine levels.

addition to clinical findings:
• Presence of hematuria, proteinuria and RBCs or granular casts on urinalysis
suggests intrinsic ARF, in particular glomerular disease.
• The presence of WBCs and WBC casts with low-grade hematuria and
proteinuria, suggests tubulointerstital disease.

01/21/2025 SAMUEL K
 cont.

1. Palpation of the bladder

2. Bladder catheterization
3. U/S: large distended bladder, hydronephrosis
• Structural anomalies – polycystic, obstruction, etc.

01/21/2025 SAMUEL K
 Complications

• Electrolyte imbalances
• Cardiovascular & hematologic cxns.
• Coma & seizures

01/21/2025 SAMUEL K
Therapy

• If patient hypovolemic replace losses

• Prompt correction of hypo-perfusion to prevent renal cell injury
1. Isotonic fluid (RL, NS)
2. Blood transfusion
3. IV albumin, 1g/kg in severe
hypo-albuminemia
4. correct cardiac failure, inotrops

01/21/2025 SAMUEL K
Therapy…
Hyperkalemia : Calcium gluconate 10% 0.5 ml/kg IV over
2-4 min with ECG monitoring
- 7.5% sodium bicarbonate, 2-3 mEq/kg over 30-60 min
-Hypertension: fluid and salt restriction,
antihypertensives,
- Dialysis

01/21/2025 SAMUEL K 155

Therapy …/3
Dialysis: severe hyperkalemia, intractable acidosis unresponsive to medical
management, dialysable toxins, massive tumor lysis, Blood urea nitrogen greater
than 100–150 mg/dL

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