Atherosclerosis

Atherosclerosis is a condition in which fatty material, such as fats and cholesterol in the bloodstream, collects along the walls of arteries. This fatty material thickens, hardens, and forms hard structures called plaques that narrow, and may eventually block blood flow through, the arteries. Narrowing and blockage of arteries results in hypertension, chest pain, transient ischemic attack (TIA) or stroke, poor circulation to legs and feet, and other cardiovascular symptoms. Atherosclerosis is a common cardiovascular disease in the United States. The disease is a leading cause of illness and death in the United States. Most commonly, people develop atherosclerosis as a result of diabetes, genetic risk factors, high blood pressure, a high-fat diet,obesity, high blood cholesterol levels, and smoking.

Common symptoms of atherosclerosis

The most common symptoms of atherosclerosis are related to disturbances in the arteries of the heart, brain and limbs. Symptoms related to disturbances in heart arteries include: Chest pain or pressure Difficulty breathing or rapid breathing (tachypnea) Symptoms related to disturbances in brain arteries include: Drooping muscle in the face Garbled or slurred speech or inability to speak Sudden numbness in the arms or legs Symptoms related to disturbances in arm and leg arteries include: Arm pain Leg pain

Serious symptoms that might indicate a life-threatening condition

In some cases, atherosclerosis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including: Blurred or double vision Change in level of consciousness or alertness, such as passing out or unresponsiveness Difficulty swallowing Difficulty with memory, thinking, talking, comprehension, writing or reading Numbness, weakness or paralysis of one side of the face Rapid breathing (tachypnea) or shortness of breath Rapid heart rate (tachycardia) Severe back pain Worst headache of your life Nursing diagnosis: Impaired tissue perfussion Impaired skin integrity Pain
Nursing interventions:

Teach about the factors which can increase blood flow : Elevate feet slightly lower than the heart (the position of elevation at rest), avoid crossing legs, avoiding tight bandage, avoid the use of pillows, hamstrings and so forth. Rational : to increase blood flow through so that does not happen edema. Teach about the modification of risk factors such as : Avoid a diet high in cholesterol, relaxation techniques, smoking cessation, and drug use vasoconstriction. Rational : high cholesterol can accelerate the occurrence of atherosclerosis, smoking can cause vasoconstriction of blood vessels, relaxation to reduce the effects of stress.

Drugs:
Aspirin Clopidogrel (Plavix)

ANEMIA
Anemia is a medical condition in which the red blood cell count or hemoglobinis less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These definitions may vary slightly depending on the source and the laboratory reference used. Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow. Anemia is caused essentially through two basic pathways. Anemia is caused by either: 1. a decrease in production of red blood cells or hemoglobin, or 2. an increase in loss or destruction of red blood cells. A more common classification of anemia (low hemoglobin) is based on the Mean Corposcular Volume (MCV) which signifies the average volume of individual red blood cells. 1. If the MCV is low (less than 80), the anemia is categorized asmicrocytic anemia (low cell volume). 2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume). 3. If the MCV is high, then it is called a macrocytic anemia (large cell volume). Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as to what could be the most common reason for anemia in each patient. Some of the most common causes include:

Vitamin B12 deficiency may causepernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons.
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Strict vegetarians are at risk if they do not take adequate vitamin supplements. Long-term alcoholics. People who have abnormal structure or function of the stomach or intestines leading to impaired B12 absorption despite adequate intake.

This typically causes macrocytic (large blood cell volume) anemia. Vitamin B12, along with folate, is involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia as well. This may also be caused by inadequate absorption, underconsumption of green, leafy vegetables, and also long-term heavy alcohol use.

There can be rupture or destruction of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells. Examples of hemolytic anemia include hemolytic disease of the newborn, medication induced hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic anemia. A wide assortment of bone marrow diseases can cause anemia.
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For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia ormultiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia. Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia. Certain infections may involve the bone marrow and result in bone marrow impairment and anemia. Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow. Chronic alcohol consumption may lead to anemia via different pathways and thus, anemia is commonly seen in alcoholics.

Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with longstanding chronic diseases. Some medications can cause anemia in a variety of ways. Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) can cause anemia.

Some patients with anemia have no symptoms. Others with anemia may feel:

Tired Fatigue easily Appear pale Develop palpitations (feeling of heart racing) Become short of breath

Additional symptoms may include:

Hair loss Malaise (general sense of feeling unwell) Worsening of heart problems

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.
Nursing diagnosis:
1. 2. 3. 4. 5. 6. 7. High risk of infection related to an inadequate secondary defenses (decreased hemoglobin leucopenia, or a decrease in granulocytes (inflammatory response depressed)). Changes in nutrition less than body requirement related to failure to digest or inability to digest the food / nutrient absorption necessary for the formation of red blood cells. Activity intolerance related to imbalance between oxygen supply (delivery) and demand. Changes in tissue perfusion related to decreased cellular components required for the delivery of oxygen / nutrients to the cells. High risk of damage to skin integrity related to circulatory and neurological changes. Constipation or diarrhea related to decreased dietary inputs; changes in the digestive process; the side effects of drug therapy. Lack of knowledge in relation to the lack of exposure / recall; incorrect interpretation of information; do not know the source of information.

Nursing intervention: Drugs:

administer oxygen to prevent sickling and organ damage. minimize patient exertion -have them lie down administer fluids and electrolytes to reduce blood viscosity encourage enough rest period.

Dexferrum Feosol Feostat Fer-In-Sol Feraheme Fergon FeroSul Ferrex-150 Venofer Vitron-C

MASTITIS
Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This causes an infection and painful inflammation of the breast. Breast infections most commonly occur one to three months after the delivery of a baby, but they can occur in women who have not recently delivered as well as in women after menopause. Other causes of infection include chronic mastitis and a rare form of cancer called inflammatory carcinoma. The breast is composed of several glands and ducts that lead to the nipple and the surrounding colored area called the areola. The milk-carrying ducts extend from the nipple into the underlying breast tissue like the spokes of a wheel. Under the areola are lactiferous ducts. These fill with milk duringlactation after a woman has a baby. When a girl reaches puberty, changing hormones cause the ducts to grow and cause fat deposits in the breast tissue to increase. The glands that produce milk (mammary glands) that are connected to the surface of the breast by the lactiferous ducts may extend to the armpit area (axilla). A breast infection that leads to an abscess (a localized pocket or collection ofpus) is a more serious type of infection. If mastitis is left untreated, an abscess can develop in the breast tissue. This type of infection may require surgical drainage. Mastitis (inflammation of breast tissue) is a common benign cause of a breast mass. It is commonly seen in women after childbirth while breastfeeding. These masses are often quite painful. Women who are not breastfeeding can also develop mastitis. In healthy women, mastitis is rare. However, women with diabetes,chronic illness, AIDS, or an impaired immune system may be more susceptible to the development of mastitis. Bacteria normally found in a baby's mouth or on the nipple can enter the milk ducts through small cracks in the skin of the nipple and can multiply rapidly in the breast milk. This can lead to a superficial small area of inflammation (frequently fromstreptococcal bacteria) or a deeper walled-off infection or abscess (frequently from staphylococcal bacteria). Mild temperature elevations (previously termed milk fever) accompanied by some breast or nipple soreness is usually secondary to engorgement and dehydrationimmediately (24-72 hours) after

delivery and is treated by improved breastfeeding technique. The body temperature should not be above 39C (102.2F), nor should the fever persist for longer than about 4-16 hours. This condition may also occur in women who are not breastfeeding and have not completely suppressed lactation yet. About one to three percent of breastfeeding mothers develop mastitis, usually within the first few weeks after delivery. Most breast infections occur within the first or second month after delivery or at the time of weaning. Typically, the infection is only in one breast. Engorgement and incomplete breast emptying can contribute to the problem and make the symptoms worse. Chronic mastitis occurs in women who are not breastfeeding. Inpostmenopausal women, breast infections may be associated with chronic inflammation of the ducts below the nipple. Hormonal changes in the body can cause the milk ducts to become clogged with dead skin cells and debris. These clogged ducts make the breast more prone to bacterial infection. This type of infection tends to come back after treatment with antibiotics.

Breast Infection Symptoms

Infection: Breast infections may cause pain, redness, and warmth of the breast along with the following symptoms: o o o o o o Tenderness and swelling Body aches Fatigue Breast engorgement Fever and chills Rigor or shaking

Abscess: Sometimes a breast abscesscan complicate mastitis. Harmless, noncancerous masses such as abscesses are more often tender and frequently feel mobile beneath the skin. The edge of the mass is usually regular and well defined. Indications that this more serious infection has occurred include the following: o Tender lump in the breast that does not get smaller after breastfeeding a newborn (If the abscess is deep in the breast, you may not be able to feel it). The mass may be moveable and/or compressible. Pus draining from the nipple Persistent fever and no improvement of symptoms within 48-72 hours of treatment

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Nursing diagnosis: risk for infection acute pain deficient knowledge

Nursing intervention:
1. 2. 3. 4. 5. 6. 7. 8. Give analgesics as indicated. Provide comfort measures such as a warm soaks. Use meticulous hand-washing technique and provide good skin care. Regularly measure the patients temperature and assess the effectiveness of antipyretic agents. Inspect the patients breast daily for signs of impaired skin integrity, such as cracks and fissures. Advise the patient to take antibiotics as ordered. Stress the need to take the entire prescribed amount even if symptoms improve in the meantime. Reassure the patient that breast-feeding during mastitis wont harm her infant because the infant is the source of the infection. 9. If only one breast is affected, instruct the patient to offer the infant his breast first to promote complete emptying and prevent clogged ducts. 10. Suggest applying a warm, wet towel to the affected breast or taking a warm shower to relax and improve her ability to breast-fed.

Drugs: Cephalexin (Keflex) dicloxacillin (Dycill) Erythromycin

BRAIN ANEURYSM
Brain aneurysm facts

Blood to the brain is supplied by four major blood vessels that join together at the Circle of Willis at the base of the brain. Smaller branch arteries leave the circle to supply brain cells with oxygen and nutrients. Artery junction points may become weak, causing ballooning of the blood vessel wall that can form a small sac or aneurysm. Cerebral aneurysms are common, but most are asymptomatic and are found incidentally at autopsy. Aneurysms can leak or rupture causing symptoms from severe headache to stroke-like symptoms, or death. The health care practitioner needs to maintain a high incidence of suspicion to make the diagnosis, since many patients may have an initial small leak of blood causing symptoms before a catastrophic bleed occurs. Diagnosis of a brain aneurysm may require CT scans, lumbar puncture, or angiography.

Treatment to repair the aneurysm may involve neurosurgery to put a clip across the weak blood vessel wall or clipping by interventional radiology.

What is a brain aneurysm and what causes a brain aneurysm?

The Circle of Willis is the junction of the four many arteries that supply the brain with nutrition (oxygen and glucose), two carotid arteries and two vertebral arteries. This loop of arteries is located at the base of the brain and sends out smaller branch arteries to all parts of the brain. The junctions where these arteries come together may develop weak spots. These weak spots can balloon out and fill with blood, creating the outpouchings of blood vessels known as aneurysms. These sac-like areas may leak or rupture, spilling blood into surrounding tissues. Aneurysms have a variety of causes including high blood pressure and atherosclerosis, trauma, heredity, and abnormal blood flow at the junction where arteries come together. There are other rare causes of aneurysms. Mycotic aneurysms are caused by infections of the artery wall. Tumors and trauma can also cause aneurysms to form. Drug abuse, especially cocaine, can cause the artery walls to inflame and weaken. Brain aneurysms (aneurysms within arteries in the brain) are a common occurrence. At autopsy, incidental asymptomatic aneurysms are found in more than 1% of people. Most aneurysms remain small and never become an issue or are diagnosed. Some, however, may gradually become larger and exert pressure on surrounding brain tissue and nerves and may be diagnosed because of symptoms such as:

headache, numbness, or weakness of one side of the face, a dilated pupil, or change in vision.

The greater concern is a brain aneurysm that leaks or ruptures, and potentially causes stroke or death. Bleeding leaks into one of the membranes that covers the brain and spinal canal and is known as a subarachnoid hemorrhage (sub= beneath + arachnoid=one of the brain coverings + hemorrhage=bleeding).

What are the signs and symptoms of brain aneurysm?

The headache associated with a leaking aneurysm is severe. Blood is very irritating to the brain and causes significant pain. Patients may describe the "worst headache of their life," and the health care practitioner needs to have an appreciation of brain aneurysm as a potential cause of this type of

pain. The headache may be associated with nausea, vomiting, and change in vision. A subarachnoid hemorrhage also causes pain and stiffness of the neck.

How is brain aneurysm diagnosed?

The diagnosis of brain aneurysm begins with a high index of suspicion by the health care practitioner. The history of the headache, an acute onset of the worst headache of the patient's life, associated with a stiff neck and an ill-appearing patient on physical examination, typically lead the health care practitioner to order a CT (computerized tomography) scan of the head. This will show a subarachnoid hemorrhage in more than 90% of cases of ruptured aneurysm. In the few cases that are not recognized by CT, the health care practitioner may consider performing a lumbar puncture(LP, or spinal tap) to identify blood in the cerebrospinal fluid that runs in the subarachnoid space. If the CT or the LP reveals the presence of blood, angiography is performed to identify where the aneurysm is located and to plan treatment. Angiography (angio=artery +graphy= picture) is a procedure in which a small flexible tube is threaded into one of the brain's arteries, and dye is injected while pictures are taken. Newer technology allows angiography to be done in association with CT or magnetic resonance imaging (MRI). Though the symptoms may suggest a brain aneurysm, other diagnoses may need to be considered. Migraine headache, meningitis, tumor, and stroke all may cause neurologic symptoms. Based on the patient's presentation, the health care practitioner will need to decide which tests and studies to use to establish the correct diagnosis. Treatment for a symptomatic aneurysm is to repair the blood vessels. Clipping and coiling are two treatment options. Clipping: A neurosurgeon can operate on the brain by cutting open the skull, identifying the damaged blood vessel and putting a clip across the aneurysm. This prevents blood from entering the aneurysm and causing further growth or blood leakage. Coiling: A neurosurgeon or interventional radiologist can thread a tube through the arteries, as with an angiogram, identify the aneurysm, and fill it with coils of platinum wire or with latex. This prevents further blood from entering the aneurysm and resolves the problem. Both these options have the risk of damaging the blood vessel and causing more bleeding, damaging nearby brain tissue, and causing the surrounding blood vessels to go into spasm; depriving brain tissue of blood supply and causing a stroke. Prior, during, and after surgery, attention is paid to protect the brain and its blood vessels from potential further damage. Vitals signs are monitored frequently, and heart monitors are used to watch for abnormal heart rhythms. Medications may be used to prevent blood vessel spasm, seizure, agitation, and pain.

Nursing diagnosis: A n x i e t y r e l a t e d t o : deterioration of physical and mental function r i s k s of treatment options Decre ased intracranial adaptive capacity related tobrain tissue injury Disturb ed thought processes related to brain mass injury Impair ed verbal communication related to damage tospeech center Risk for acute confusion related to tissue damage from brainmass Risk for injury related to increased seizure potential and neuro-muscular effects of brain tissue damage Nursing intervention:
1. 2.

Establish and maintain a patent airway as needed. Administer supplemental oxygen as ordered. 3. Position the patient to promote pulmonary drainage and prevent upper airway obstruction. 4. Avoid placing the patient in the prone position as well as hyperextending his neck. 5. Suction secretions from the airway as necessary to prevent hypoxia and vasodilation from carbon dioxide accumulation. 6. Monitor pulse oximetry levels and arterial blood gas level as ordered. Use these levels as a guide to determine appropriate needs for supplemental oxygen. 7. Prepare the patient for emergency craniotomy, if indicated. 8. If surgery cant be performed immediately, institute aneurysm precautions to minimize the risk of rebleeding and to avoid increasing the patients intracranial pressure. 9. Administer hydralazine or another antihypertensive agent as ordered. 10. Turn the patient often. Encourage deep breathing and leg movement. 11. Apply elastic stockings or compression boots to the patients legs to reduce the risk of deep vein thrombosis. 12. Give fluids as ordered and monitor I.V. infusions to avoid overhydration, which may increase ICP. 13. If the patient has facial weakness, assist him during meals; assess his gag reflex and place the food in the unaffected side of his mouth. 14. Implement a bowel elimination program based on previous habits. 15. Raise the beds side rails to protect the patient from injury. 16. Provide emotional support to the patient and his family.

TONSILLITIS
Tonsillitis (ton-sil-lie-tiss) is an inflammation of the tonsils caused by an infection. In tonsillitis, the tonsils are enlarged, red, and often coated (either partly or entirely) by a substance that is yellow, gray, or white. Tonsillitis usually occurs as part of a pharyngitis (throat infection). Tonsillitis usually begins with sudden sore throat and painful swallowing. Sometimes, tonsillitis reoccurs, and may cause difficulty breathing. If this occurs, your doctor may recommend taking them out. This procedure of removing tonsils from the throat is called a tonsillectomy.

Each person with tonsillitis may not experience all of the symptoms. Some of the major symptoms of tonsillitis are: a very sore throat fever redder-than-normal tonsils chills a yellow or white coating on the tonsils a funny-sounding voice swollen glands in the neck bad breath

nursing diagnosis:
Nursing Diagnosis for Tonsillitis : Preoperative 1. 2. 3. 4. 5. Swallowing disorders related to inflammatory processes. Acute pain related to tonsil tissue swelling. Imbalance nutrition less than body requirements related to tonsil tissue swelling. Hipertermi related to the disease process. Anxiety related to discomfort. Nursing Diagnosis for Tonsillitis : Postoperative 1. 2. 3. Acute pain related to surgical incision, tissue discontinuities. High risk of infection related to invasive procedures. Lack of knowledge about the diet related to less information.

Nursing intervention:

Encourage increase fluid intake of warm water Encourage enough sleep Gargle water with salt to lessen sore throat Administer medication to relieve pain

Drugs: Antibiotics, such as penicillin, are used to treat tonsillitis caused by strep bacteria. acetaminophen (Tylenol)