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Learning Activity Week 5 Med Surg - Rosie

Learning Activity Week 5 Med Surg - Rosie

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Published by Kayla Mayer

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Published by: Kayla Mayer on Jan 23, 2012
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Learning Activity week 5Congestive Heart Failure, Cerebrovascular Accidents, Cardiac ArrhythmiasHow does hypertension lead to congestive heart failure?
Hypertension is a major contributing factor for the development of HF. The risk of HF increases progressively with the severity of hypertension and systolic and diastolic hypertension equally predict risk.
Pathology of Ventricular failure (Systolic heart failure)Systolic heart failure
is the most common type of HF, results from an inability of the heart to pump blood. It is caused by a defect in the ability of the ventricles to contract (pump) or byincreased afterload or mechanical abnormalities. The left ventricle loses its ability to generateenough blood pressure to eject blood forward through the high pressure aorta. The hallmark of systolic HF is a decrease in the left ventricular ejection fraction (the fraction or percentage of total amount of blood in the LV that is ejected during each ventricular contraction). Systolic HFis caused by impaired contractile function (e.g myocardial infarction) increased afterload (eghypertension) cardiomyopathy, and mechanical abnormalities (eg valvular heart disease).
Diastolic heart failure
is an impaired ability of the ventricles to fill during diastole. Decreasedfilling of the ventricles will result in decreased stroke volume. Diastolic HF is characterized byhigh filling pressures and the resultant venous engorgement in both the pulmonary and thesystemic vascular systems. The diagnosis of diastolic HF is made on the basis of the presence o pulmonary congestion, pulmonary hypertension, ventricular hypertrophy and a normal EF.Diastolic HF is usually the result of left ventricular hypertrophy from chronic systemichypertension, aortic stenosis, or hypertrophic cardiomyopathy.
Create a flowchart pattern to recognize the S&S of left sided and right sided heart failure.Left sided failure
results from LV dysfunction, which causes blood to back up through the leftatrium and into the pulmonary veins. The increased pulmonary pressure causes fluidextravasation from the pulmonary capillary bed into the interstitium and then the alveoli which ismanifested as pulmonary congestion and edema.
Right sided heart failure
causes backward blood flow to the right atrium and venouscirculation. Venous congestion in the systemic circulation results in peripheral edema,hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal (GI) tract and jugular venous distention. Primary cause of right sided heart failure is left sided failure.
 
Clinical Manifestations of Heart FailureRight sided heart failure Left sided heart failureSigns
LV heavesRV heaves Cheyne-Stroke respirationsMurmurs Pulsus alternans (alternating pulses: strong,weak)Peripheral edema Increased heart rateWeight gain PMI displaced inferiorly and posteriorly (LVhypertrophy)Increased heart rate ^ Pa02 slight ^PaC02 (poor 02 exchnage)Edema of dependent body parts (sacrum,anterior tibias, pedal edema)Crackles (pulmonary edema)Ascites S3 and S4 heart soundsAnasarca (massive generalized body edema)Jugular venous distensionHepatomegaly (liver enlargement)Right sided pleural effusion
Symptoms
FatigueDependent edemaRight upper quadrant painAnorexia and GI bloating NauseaFatigueDyspnea (shallow respirations up to 32-40/min)Orthopnea (shortness of breath in recumbent position)Dry, hacking coughPulmonary edema NocturiaParoxysmal nocturnal dyspnea
What diagnostic test would help to determine the origin of heart failure?Diagnostic studies-
Measures to assess the cause and degree of HF include a through history, physical examination, chest radiograph, electrocardiogram (ECG), laboratory data (cardiacenzymes, BNP, serum chemistries, liver function studies, thyroid function studies abd complete blood count (CBC), hemodynamic assessment, echocardiogram, stress testing and cardiaccatheterization.
Transient Ischemic Attack 
is a temporary focal loss of neurological function caused byischemia of one of the vascular territories of the brain, lasting less than 24 hours and often lastingless than 15 minutes. Most TIA resolve within 3 hours. TIA¶s may be due to micro emboli thattemporarily block the blood flow. TIA¶s are a warning sign of progressive cerebrovascular disease.
 
Thrombotic stroke,
which is a result of thrombosis or narrowing of the blood vessel is the mostcommon cause of stroke, accounting for 61% of strokes. Two thirds of thrombotic strokes areassociated with hypertension or diabetes mellitus, both of which accelerate atherosclerosis.Ischemic stroke symptoms may progress in the first 72 hours as infarction and cerebral edemaincrease.
Embolic stroke
occurs when an embolus lodges in and occludes a cerebral artery, resulting ininfarction and edema of the area supplied by the involved vessel. Embolism is the second mostcommon cause of stroke. Plaque breaks off from the endocardium and enters the circulation. Theembolus travels upward to the cerebral circulation and lodges where a vessel narrows or  bifurcates.
Clinical Manifestations
A stroke can have an effect on many body functions such as:
Motor function-
motor deficits are the most obvious effect of stroke. Motor defecits includeimpairment of mobility, respiratory function, swallowing, and speech, gag reflex, self careabilities. Symptoms are caused by the destruction of motor neurons in the pyramidal pathway.The characteristic motor deficits include loss of skilled voluntary movement (akinesia),impairment of integration of movements, alterations in muscle tone, and alterations in reflexes.
Communication
the left hemisphere is dominant for language skills in right handed persons andin most left handed persons. The client may experience
aphasia
(an abnormal neurologicalcondition in which language function is disordered or absent because of an injury to certain areasof the cerebral cortex) when a stroke damages the dominant hemisphere of the brain.
Affect
clients may have difficulty controlling their emotions. Emotions responses may beexaggerated or unpredictable. Depression and feelings associated with changes in body imageand loss of function can make this worse.
Intellectual function
both memory and judgement may be impaired as a result of stroke. A left brain stroke is more likely to result in memory problems related to language. Clients with left brain stroke are often very cautious in making judgments. The client with a right brain stroketends to be impulsive and to move quickly. An example of behaviour with right brain stroke isthe client who tries to rise quickly from the wheelchair without locking the wheels or raising thefoot rests. The client with a left brain stroke would move slowly and cautiously from thewheelchair.
Elimination
when a stroke affects a hemisphere of the brain, the prognosis for normal bladder function is excellent. Partial sensation of the bladder filling remains and voluntary urination is present. Initially the client may experience frequency, urgency and incontinence. Clients are

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