Atherosclerosis

Atherosclerosis is thickening or hardening of the arteries caused by a buildup of plaque in the inner
lining of an artery. Risk factors may include high cholesterol and triglyceride levels, high blood pressure,
smoking, diabetes, obesity, physical activity, and eating saturated fats.
Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown,
atherosclerosis may start with damage or injury to the inner layer of an artery.

The damage may be caused by:

-High blood pressure
- High cholesterol
- High triglycerides, a type of fat (lipid) in your blood
- Smoking and other sources of tobacco
-Insulin resistance, obesity or diabetes
-Inflammation from an unknown cause or from diseases such as arthritis, lupus, psoriasis
or inflammatory bowel disease
Mild atherosclerosis usually doesn't have any symptoms.
Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example:
-atherosclerosis in your heart arteries - chest pain or pressure (angina).
-atherosclerosis in the arteries leading to the brain - sudden numbness or weakness in your arms or legs, difficulty
speaking or slurred speech, temporary loss of vision in one eye, or drooping muscles in you face. These signal a transient
ischemic attack (TIA), which, if left untreated, may progress to a stroke.
atherosclerosis in the arteries in the arms and legs - may have signs or symptoms of peripheral artery disease, such as leg
pain when walking (claudication) or decreased blood pressure in an affected limb.
atherosclerosis in the arteries leading to the kidneys – may develop high blood pressure or kidney failure.

Complications of atherosclerosis include:

-Aneurysms
-Angina
- Chronic kidney disease
-Heart attack
- Heart failure
-Peripheral artery disease
-Stroke
- Unusual heart rhythms
- Coronary artery disease (CAD), Myocardial Infarction, acute coronary syndrome (ACS), or heart attack.
Atherosclerosis may cause total blockage of a coronary artery, which may result to the lack of blood
flow to the cardiac muscle.
- Heart Failure. Since the coronary arteries supply the heart with oxygen- and nutrient-rich blood, blockage in them may
weaken the heart. This eventually leads to failure of the heart to supply blood to
the rest of the body tissues.
-Peripheral vascular disease (PVD). Blockage of a peripheral artery may lead to reduced blood flow to the limbs, usually
the legs. This can manifest as leg weakness and pain and can affect the mobility of the
patient.
-Arrythmias. Abnormal heart rhythms such as atrial fibrillation may result from the decreased blood
supply in the heart. Irregular heartbeats may result to formation of more blood clots. These thrombi
 can travel to other parts of the body and become embolus/ emboli. When the embolus reaches the
brain, the patient may suffer from transient ischemic attack (TIA) or stroke.

Nursing Care Management/Responsibilities

a.Assess the patient for pain
b. Monitor vital signs of patient
c.Assess client’s learning needs

d.Explain the risk factors related to atherosclerosis and focus on lifestyle changes
e. Encourage adherence of cholesterol lowering medications and other medications
f. Recommend client to follow attend follow up check ups to monitor disease progression
g. Encourage patient to adhere to recommended dietary control

Arteriosclerosis
Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from the heart to the rest of the body
(arteries) become thick and stiff — sometimes restricting blood flow to
the organs and tissues

Causes:
-High cholesterol
- High blood pressure
-High triglycerides
-Insulin resistance or diabetes
- Obesity
- Smoking or use of other tobacco products
-Inflammation from other diseases

Signs and Symptoms

- sudden weakness
-facial or lower limb numbness
- confusion
- difficulty understanding speech
-problems seeing

Complications of arteriosclerosis include:

-Coronary Arteriosclerosis (Coronary artery disease): Narrowed arteries near the heart may lead to
chestpain, heart attack or heart failure.
- Peripheral artery disease: Narrowed arteries in the arms or legs may cause circulation problems
that make it difficult to feel heat and cold, and cause gangrene that can lead to limb
amputation.
-Carotid artery disease: Narrowed arteries near the brain may cause transient ischemic attack (TIA)
 or stroke.
- Aneurysms: A bulge in the wall of an artery, if it bursts, can cause a slow leak or life-threatening internal bleeding.
-Chronic kidney disease: Narrow arteries near the kidneys can prevent effective kidney function.

Nursing Care Management/Responsibilities

-Assess and document patient response to medication.
- Maintain quiet, comfortable environment. Restrict visitors as necessary.
-Monitor serial ECG changes.
- Review importance of weight control, cessation of smoking, dietary changes, and exercise.
-Review significance of cholesterol levels and differentiate between LDL and HDL factors. Emphasize importance of
periodic laboratory measurements
-Discuss impact of illness on desired lifestyle and activities, including work, driving, sexual activity, and hobbies. Provide
information, privacy, or consultation, as indicated

Coronary Artery Disease

Coronary artery disease develops when the major blood vessels that supply your heart become
damaged or diseased.
CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called
coronary arteries) and other parts of the body.
Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes
the inside of the arteries to narrow over time, which can partially or totally block the blood flow. This process is called
atherosclerosis.

Complications:
-Chest pain (angina). When your coronary arteries narrow, your heart may not receive enough blood
when demand is greatest — particularly during physical activity. This can cause chest pain
(angina) or shortness of breath.
- Heart attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage of your
 heart artery may trigger a heart attack. The lack of blood flow to your heart may damage your heart muscle. The
amount of damage depends in part on how quickly you receive treatment.
-Heart failure. If some areas of your heart are chronically deprived of oxygen and nutrients because
of reduced blood flow, or if your heart has been damaged by a heart attack, your heart may
become too weak to pump enough blood to meet your body's needs. This condition is known as heart
failure.
- Abnormal heart rhythm (arrhythmia). Inadequate blood supply to the heart or damage to heart
tissue can interfere with your heart's electrical impulses, causing abnormal heart rhythms.

Symptoms:
For many people, the first clue that they have CAD is a heart attack. Symptoms of heart attack include
a.Chest pain or discomfort (angina)
b.Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat
c.Pain or discomfort in the arms or shoulder
d.Shortness of breath
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t
pump blood the way it should.

Nursing Care Management/Responsibilities

-Monitor blood pressure, apical heart rate, and respirations every 5 minutes during an anginal attack.
- Maintain continuous ECG monitoring or obtain a 12-lead ECG, as directed, monitor for arrhythmias and ST elevation.
-Place patient in comfortable position and administer oxygen, if prescribed, to enhance myocardial oxygen supply.
-Identify specific activities patient may engage in that are below the level at which anginal pain occurs.
- Reinforce the importance of notifying nursing staff whenever angina pain is experienced.
-Encourage supine position for dizziness caused by antianginals.
-Be alert to adverse reaction related to abrupt discontinuation of beta-adrenergic blocker and calcium channel blocker
therapy. These drug must be tapered to prevent a “rebound phenomenon”; tachycardia, increase in chest pain, and
hypertension.
-Explain to the patient the importance of anxiety reduction to assist to control angina.
-Teach the patient relaxation techniques.
-Review specific factors that affect CAD development and progression; highlight those risk factors that can be modified
and controlled to reduce the risk.

Cardiomegaly
An enlarged heart (cardiomegaly) refers to a heart that is bigger than typical. The heart may be
unusually thick or dilated (stretched). An enlarged heart may be temporary or permanent, depending on the cause.

Common causes of an enlarged heart include:

-Anemia
-Arrhythmia (heart rhythm changes)
- Cardiomyopathy
-Congenital heart disease
- Heart valve disease
-Thyroid disease
- High blood pressure. Your heart may have to pump harder to deliver blood to the rest of your body, enlarging and
thickening the muscle. High blood pressure can cause the left ventricle to
enlarge, causing the heart muscle eventually to weaken. High blood pressure may also enlarge the
upper chambers of your heart.
-Heart valve disease. Four valves in your heart keep blood flowing in the right direction. If the valves are damaged by
conditions such as rheumatic fever, a heart defect, infections (infectious endocarditis), an
irregular heartbeat (atrial fibrillation) connective tissue disorders, certain medications or
radiation treatments for cancer, your heart may enlarge.
-Cardiomyopathy. This disease of the heart makes it harder for your heart to pump blood
throughout your body. As it progresses, your heart may enlarge to try to pump more blood.
-High blood pressure in the artery that connects your heart and lungs (pulmonary hypertension). Your heart may need to
pump harder to move blood between your lungs and your heart. As a result, the right side of your heart may enlarge.
- Fluid around your heart (pericardial effusion). Accumulation of fluid in the sac that contains your heart may cause your
heart to appear enlarged on a chest X-ray.
-Blocked arteries in your heart (coronary artery disease). With this condition, fatty plaque in your heart arteries obstruct
blood flow through your heart vessels, which can lead to a heart attack. When a section of heart muscle dies, your heart
has to pump harder to get adequate blood to the rest of your body, causing it to enlarge.
- Low red blood cell count (anemia). Anemia is a condition in which there aren't enough healthy red blood cells to carry
adequate oxygen to your tissues. Untreated, chronic anemia can lead to a rapid or irregular heartbeat. Your heart must
pump more blood to make up for the lack of oxygen in the blood.
- Thyroid disorders. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland
(hyperthyroidism) can lead to heart problems, including an enlarged heart.
- Excessive iron in the body (hemochromatosis). Hemochromatosis is a disorder in which your body
doesn't properly metabolize iron, causing it to build up in various organs, including your heart.
This can cause an enlarged left ventricle due to weakening of the heart muscle.
-Rare diseases that can affect your heart, such as amyloidosis. Amyloidosis is a condition in which
abnormal proteins circulate in the blood and may be deposited in the heart, interfering with your
heart's function and causing it to enlarge.

Signs and symptoms

-Dizziness
-Edema (swelling), especially in the legs, feet or abdomen
-Fatigue, or being unusually exhausted
-Heart fluttering
- Shortness of breath

Complications
- Heart failure. An enlarged left ventricle, one of the most serious types of enlarged heart, increases the risk of heart
failure. In heart failure, your heart muscle weakens, and the ventricles
stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body.
 -Blood clots. Having an enlarged heart may make you more susceptible to forming blood clots in the lining of your heart.
If clots enter your bloodstream, they can block blood flow to vital organs, even causing a heart
attack or stroke. Clots that develop on the right side of your heart may travel to your lungs, a dangerous condition called
a pulmonary embolism.
-Heart murmur. For people whose hearts are enlarged, two of the heart's four valves — the mitral and tricuspid valves
— may not close properly because they become dilated, leading to a backflow of blood. This flow creates sounds called
heart murmurs. Although not necessarily harmful, heart murmurs should be
monitored by your doctor.
- Cardiac arrest and sudden death. Sometimes an enlarged heart can lead to disruptions in your
heart's beating rhythm.
-Heart rhythms that are too slow to move blood or too fast to allow the heart to beat properly
can result in fainting or, in some cases, cardiac arrest or sudden death.

Nursing Responsibilities
-Assess heart rate and blood pressure
-Check for peripheral pulses. Perform capillary refill test (CRT)
-Assess oxygen saturation with pulse oximetry both at rest and during and after ambulation
-Note chest pain. Identify location, radiation, severity, quality, duration, associated manifestations such as nausea, and
precipitating and relieving factors
-Note chest pain. Identify location, radiation, severity, quality, duration, associated manifestations such as nausea, and
precipitating and relieving factors
-Closely monitor for symptoms of heart failure and decreased cardiac output
-Assess for reports of fatigue and reduced activity tolerance
-Ascertain contributing factors so an appropriate care plan can be initiated
-Monitor electrocardiogram (ECG) for rate, rhythm, and ectopy
-Observe patient for understanding and compliance with medical regimen, including medications, activity level, and diet

Heart Failure

Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn't pump blood as well
as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.
Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high bloodpressure, gradually
leave the heart too weak or stiff to fill and pump blood properly.

Heart failure can be caused by many medical conditions that damage the heart muscle. Common conditions are:

-Coronary artery disease (also called coronary atherosclerosis or “hardening of the arteries”) affects the arteries that
carry blood and oxygen to the heart (coronary arteries). The normal lining inside the arteries breaks down, the walls of
the arteries become thick, and deposits of fat and plaque partially block the flow of blood. Over time, the arteries
become very narrow or completely blocked, which causes a heart attack. The blockage keeps the heart from being
able to pump enough blood to keep your organs and tissues (including your heart) healthy. When arteries are blocked,
you may have chest pain (angina) and other symptoms of heart disease.

- Heart attack. A heart attack happens when a coronary artery suddenly becomes blocked and blood cannot flow to all
areas of the heart muscle. The heart muscle becomes permanently damaged and muscle cells may die. Normal heart
muscle cells may work harder. The heart may get bigger (HF-rEF) or stiff (HF-pEF).
- Cardiomyopathy. Cardiomyopathy is a term that describes damage to and enlargement of the heart muscle not by
problems with the coronary arteries or blood flow. Cardiomyopathy can occur
due to many causes, including viruses, alcohol or drug abuse, smoking, genetics and pregnancy
(peripartum cardiomyopathy).
-Heart defects present at birth (congenital heart disease)
- Diabetes.
 - High blood pressure (hypertension). Blood pressure is the force of blood pushing against the walls of your blood vessels
(arteries). If you have high blood pressure, it means the pressure in your
arteries is higher than normal. When blood pressure is high, your heart has to pump harder to\
move blood to the body. This can cause the left ventricle to become thick or stiff, and you can
develop HF-pEF. High blood pressure can also cause your coronary arteries to become narrow and
lead to coronary artery disease.
- Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
- Kidney disease.
- Obesity (being overweight).
-Tobacco and illicit drug use.
-Medications. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.

Symptoms
-Fatigue
- Shortness of Breath (Dyspnea)
-Fluid Retention (Edema) and Weight Gain
-Wheezing or Cough
-Loss of Muscle Mass
- Gastrointestinal Symptoms
- Pulmonary Edema
-Abnormal Heart Rhythms
-Central Sleep Apnea

Complications
-Atrial fibrillation
-Ventricular fibrillation or tachycardia
-Kidney failure
- Anemia
-Stroke
-Heart valve condition
-Cardiac cachexia
- Leg venous stasis and ulcers
- Congestion (Fluid Buildup)

Nursing Interventions
In cases of rapid response:
a.Quickly assess the client
b. administer sublingual nitroglycerin and aspirin, if indicated
c. Obtain a 12 lead EKG
d. notify the physician

-Assess for chest pain not relieved by rest or medications

-Monitor vital signs, especially the blood pressure and pulse rate
- Assess for presence of shortness of breath, dyspnea, tachypnea, and crackles
-Assess for nausea and vomiting
- Assess for decreased urinary output
- Assess for the history of illnesses
- Perform a precise and complete physical assessment to detect complications and changes in the patient’s status
-Assess IV sites frequently

Dysrhythmias
Dysrhythmia is an abnormality in the heart's beat or rhythm caused by electrical impulses that
aren't functioning properly. The heart can beat irregularly, too quickly (tachycardia), or too slowly
(bradycardia)

Causes
-Heart disease
-An electrolyte imbalance (such as sodium and potassium)
-Changes to the heart muscle
-Injury from a heart attack
- Healing after heart surgery

Signs and Symptoms

- Chest pain or tightness
-Dizziness or lightheadedness
-Fainting
-Palpitations – a feeling of skipped heartbeats or fluttering
-Pounding in the chest
-Shortness of breath
-Weakness or fatigue

Complications:
-Congestive heart failure: If the heart rhythm is abnormal for an extended period of time, the heart muscle may become
weak and fail to pump blood efficiently throughout the body.

-Fainting (syncope): A heart that’s out of rhythm may not be able to pump blood efficiently to
the brain. If this occurs, a person may faint and sustain injuries during the fall.

-Stroke: Certain dysrhythmias, like atrial fibrillation, can cause small blood clots to form in the
heart. If these clots break loose and move through the bloodstream to the brain, they could
cause a stroke. Risk of stroke depends on age, type of dysrhythmia and whether any other
cardiovascular risk factors for stroke, such as high blood pressure, are present.

- Sudden death: Ventricular dysrhythmia in people with structural heart disease — such as a
weakened heart muscle from a previous heart attack — or undetected Long QT syndrome can lead
to sudden cardiac arrest and death.

Nursing Care Management/Responsibilities

-Assess for and report signs/symptoms of cardiac dysrhythmias (e.g. irregular apical pulse, adult pulse rate below 60 or
above 100 beats/minute, apical-radial pulse deficit, syncope, palpitations).
-Reduce cardiac workload
-Initiate EKG monitor and pulse oximetry per policy.
-IV access, O2, medication and 12 lead-EKG as ordered, monitor vital signs.
-Assess for contributing factors: pain, fluid and electrolyte imbalance, drug toxicity (especially digoxin), medication non
adherence.
-Investigate reports of chest pain, documenting location, duration, intensity (0–10 scale), and relieving or aggravating
factors. Note nonverbal pain cues: facial grimacing, crying, changes in BP/heart rate.
-Prepare for invasive diagnostic procedures and surgery as indicated.

Anemia
Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues.
Having anemia, also referred to as low hemoglobin, can make you feel tired and
weak. There are many forms of anemia, each with its own cause. Anemia can be temporary or long
term and can range from mild to severe. In most cases, anemia has more than one cause. Anemia
can be a warning sign of serious illness.

Causes
- The body doesn't make enough red blood cells
-Bleeding causes you to lose red blood cells more quickly than they can be replaced
-The body destroys red blood cells

-Iron deficiency anemia. This most common type of anemia is caused by a shortage of iron in your body. Your
bonemarrow needs iron to make hemoglobin. Without adequate iron, your body can't
produce enough hemoglobin for redblood cells.

-Without iron supplementation, this type of anemia occurs in many pregnant women. It's also caused by blood loss, such
as from heavy menstrual bleeding; an ulcer in the stomach or small bowel; cancer
of the large bowel; and regularuse of some pain relievers that are available without
prescription, especially aspirin, which can cause inflammation of the stomach lining resulting in
blood loss. It's important to determine the source of iron deficiency to prevent recurrence of
the anemia.

-Vitamin deficiency anemia. Besides iron, your body needs folate and vitamin B-12 to produce enough healthy red blood
cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Some people who
enough B-12 aren't able to absorb the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious
anemia.
-Anemia of inflammation. Certain diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn's
disease and other acute or chronic inflammatory diseases — can interfere with the production of red blood cells.
-Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't produce enough red blood cells.
Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals.
Anemias associated with bone marrow disease. A variety of diseases, such
as leukemia and myelofibrosis, can causeanemia by affecting blood production in your bone marrow.
The effects of these types of cancer and cancer-likedisorders vary from mild to life-threatening.
-Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow
canreplace them. Certain blood diseases increase red blood cell destruction. You can
inherit a hemolytic anemia, or you develop it later in life.
-Sickle cell anemia. This inherited and sometimes serious condition is a hemolytic anemia. It's caused
by a defectiveform of hemoglobin that forces red blood cells to assume an abnormal crescent
(sickle) shape. These irregular bloodcells die prematurely, resulting in a chronic shortage of red
blood cells.

Signs and symptoms

-Fatigue
-Weakness
-Pale or yellowish skin
-Irregular heartbeats
-Shortness of breath
-Dizziness or lightheadedness
-Chest pain
- Cold hands and feet
- Headaches

Complications
-Lasting fatigue leading to diminished productivity
-Weakened immune system
-Fast or irregular heartbeat
- Heart failure
-Problems during pregnancy, including fatigue, premature labor and problems with fetal development
- Increased risk of postpartum depression

Nursing Care Management/Responsibilities

-Assess the client’s ability to perform activities of daily living (ADLs) and the demands of daily living
- Monitor hemoglobin, hematocrit, RBC counts, and reticulocyte counts
- Anticipate the need for the transfusion of packed RBCs
- Assess current knowledge of the diagnosis, disease process, possible causative factors, and treatment
- Explain the importance of the diagnostic procedures (such as complete blood count), bone marrow aspiration, and
apossible referral to a hematologist
- Educate the client and the family regarding food rich in iron, folic acid, and vitamin B12
-Explain that a transfusion of packed RBCs may be needed
- Instruct the client about certain medications that may stimulate RBC production in the bone marrow

Polycythemia

Polycythemia refers to an increase in the number of red blood cells in the body. The extra cells cause the blood to
bethicker, and this, in turn, increases the risk of other health issues, such as blood clots.
Polycythemia can have different causes, each of which has its own treatment options. The treatment of polycythemia
involves treating any underlying conditions, if possible, and finding ways to bring blood cell levels down.

There are two types of polycythemia, which have different causes.

Primary polycythemia
Primary polycythemia is also called polycythemia vera (PV).
PV is a rare, slow growing blood cancer that is a type of condition known as a myeloproliferative neoplasm. PV
causes bone marrow to create excess precursor blood cells that develop and function abnormally, leading to theproduction
of too many red blood cells.
A person with PV may also have increased numbers of other blood cells, such as white blood cells or platelets.

Secondary polycythemia
Secondary polycythemia can occur if the increase in red blood cells is not due to the myeloproliferative disease of PV.
The overproduction of blood cells in secondary polycythemia is limited to the red blood cells.
Causes of secondary polycythemia include:

-being at a very high altitude

-obstructive sleep apnea
- certain types of tumor
-heart or lung disease that causes a low oxygen level in the body

Signs and symptoms

-dizziness or vertigo
- headaches
-excessive sweating
-itchy skin
-ringing in the ears
-blurred vision
-fatigue
-reddish or purplish skin on the palms, earlobes, and nose
- bleeding or bruising
- a burning sensation in the feet
-abdominal fullness
-frequent nosebleeds
- bleeding gums

Complications
- enlarged spleen
-blood clots
-angina
-stroke
- peptic ulcers
- heart disease
-gout
-other blood disorders, such as myelofibrosis or leukemia

Nursing Care Management/Responsibilities

- Assess for presence of headache, angina, abdominal pain, and joint pain. Devise a pain scale with patient, rating
discomfort from 0 (no pain) to 10 (worst pain).
- Assess for patient complaints of calf pain and tenderness
- In the presence of joint or skin discomfort, rest the joint and elevate the extremity. Use
gentle range-of-motion (ROM) exercises as tolerated. Caution patient to avoid crossing legs and
wearing restrictive clothing. Apply cool compressesor ice.
-Encourage use of nonpharmacologic pain control, such as relaxation and distraction.
-Instruct client to avoid low-oxygen environments
-Assess the client’s ability to perform activities of daily living (ADLs) and the demands of daily
living
- Monitor hemoglobin, hematocrit, RBC counts, and reticulocyte counts

Thrombocytopenia
Thrombocytopenia occurs when your blood platelet count is low. Platelets are also called thrombocytes. This type of
blood cell clumps together to form blood clots to help stop bleeding at the site of a cut or wound. Another name for a
blood clot is thrombus

Signs and symptoms

-Epistaxis or nosebleed.
-Bleeding gums
- Hemoptysis – coughing of blood
-Hematemesis – vomiting of blood
- Hematuria or passing of blood in urine
-Hematochezia -the presence of fresh red blood in the stool
-Melena -passage of dark, tarry stool.
-Metromenorrhagia in women –irregular and persistent uterine bleeding
-Post-partum hemorrhage in women
-Excessive post-surgical bleeding in minor and major surgeries
-Bleeding after aspirin intake
- Spontaneous bruising
-Petechial rash
- Fatigue
- Enlarged spleen
Causes
- Trapped platelets in the spleen. About a third of the body’s platelets are housed in the spleen. Any condition that causes
enlargement of the spleen can cause it to trap more platelets than usual, hence affecting the number of platelets in the
blood circulation. Enlargement of spleen can be seen in cirrhosis and splenomegaly.
- Reduction in platelet production. Conditions that affect the function of the bone marrow can also cause low platelet
count. Leukemia and other cancers, some types of anemia, hepatitis, HIV and other viral illnesses, chemotherapy and
radiation therapy, and heavy alcohol consumption can cause suppression in the bone marrows ability to produce blood
products including platelets.
-Increased destruction of platelets. Platelets have a lifespan of 8-10 days. However, there are some conditions that cause
the breakdown of platelets sooner than they should. These conditions include:
- Pregnancy. Pregnancy usually causes mild thrombocytopenia which settles immediately after birth.
-Immune thrombocytopenia. This is commonly referred to as idiopathic thrombocytopenic purpura. It is an autoimmune
condition where the body attacks its own platelets. The cause is still unknown.
-Bacterial infection. Severe bacterial infection affecting the blood or bacteremia can cause the destruction of platelets in
the blood.
-Thrombotic thrombocytopenic purpura. It is a condition characterized by the sudden formation of small blood clots
throughout the body causing the use of most of the platelets in circulation.
-Hemolytic uremic syndrome. This condition is characterized by the inflammation of the small blood vessels in the
kidneys, leading to kidney failure. The damage to the small blood vessels causes the formation of blood clots causing the
destruction of red blood cells and platelets.
-Medication. Some medications can reduce platelet levels. Examples are heparin, quinine, anticonvulsants, and antibiotics
that have a sulfa component.

Complications
-Adverse effects of treatment.
- Anemia.
-Excessive or uncontrollable bleeding.
-Gastrointestinal bleeding.
-Intracerebral hemorrhage (bleeding in the brain)
-Severe nosebleeds

Nursing Care Responsibilities

-Assess client’s energy level and fatigueability, as well as his/her usual activities of daily living (ADLs)
-Ensure that the floor is free from objects that may cause the client to slip and fall
- Monitor hemoglobin, hematocrit, RBC counts, and reticulocyte counts
- Assess current knowledge of the diagnosis, disease process, possible causative factors, and treatment
- Explain the importance of the diagnostic procedures (such as complete blood count), bone marrow
aspiration, and a possible referral to a hematologist

Disseminated intravascular coagulation (DIC)

Disseminated intravascular coagulation (DIC) is a rare, life-threatening condition. In the early stages of the condition, DIC
causes your blood to clot excessively. As a result, blood clots may reduce blood flow and block blood from reaching
bodily organs. As the condition progresses, platelets and clotting factors, the substances in your blood responsible for
forming clots, are used up. When this happens, you will begin to experience excessive bleeding. DIC is a serious
condition that can lead to death.

Causes
When the body is injured, proteins in the blood that form blood clots travel to the injury site to help stop bleeding. If these
proteins become abnormally active throughout the body, it could develop DIC. The underlying cause is usually due to
inflammation, infection, or cancer.

In some cases of DIC, small blood clots form in the blood vessels. Some of these clots can clog the vessels and cut off the
normal blood supply to organs such as the liver, brain, or kidneys. Lack of blood flow can damage and cause major to the
organs.

In other cases of DIC, the clotting proteins in the blood are consumed. When this happens, an individual may have a high
of serious bleeding, even from a minor injury or without injury. It may also have bleeding that starts spontaneously (on its
own). The disease can also cause the healthy red blood cells to fragment and break up when they travel through the small
vessels that are filled with clots.

Signs and Symptoms

Bleeding, sometimes from multiple locations on the body, is one of the more common symptoms of DIC.
Bleeding from the mucosal tissue (in the mouth and nose) and other external areas may occur. In
addition, DIC may cause internal bleeding.

Other symptoms are:

-blood clots
- decreased blood pressure
-easy bruising
-rectal or vaginal bleeding
-red dots on the surface of the skin (petechiae)

Complications
DIC can cause complications, especially when it isn’t treated properly. Complications can occur from both the excessive
clotting that happens in the early stages of the condition and the absence of clotting factors in the later stages.
Complications include:
-blood clots that cause a lack of oxygen to limbs and organs
- stroke
-excessive bleeding that may lead to death

Nursing Care Responsibilities

-Assess the client’s breath sounds. Assess cough for signs of bloody sputum.
-Assess the respiratory depth, rate, and rhythm.
-Assess for tachycardia, shortness of breath, and use of accessory muscles.
-Monitor oxygen saturation and assess arterial blood gases (ABGs).
-Maintain an oxygen administration device as ordered.
-Assess for chest pain and shortness of breath.
-Monitor platelet count.
- Monitor PT (prothrombin time) and PTT (partial thromboplastin time).
-Monitor D-dimer levels.
- Administer heparin as prescribed
-Carefully explain the underlying cause that precipitated DIC.
- Instruct the client or significant others to notify the nurse of new bleeding from wounds or IV sites.
- Assess the client’s heart rate and blood pressure. Observe for signs of orthostatic hypotension.
-Note any hemoptysis or blood obtained during suctioning.
- Observe for signs of external bleeding from the gastrointestinal (GI) and genitourinary (GU) tracts.
-Monitor hemoglobin and hematocrit levels.
 References

Arteriosclerosis Signs, Symptoms & Treatments | Baptist Health. (n.d.). Www.baptisthealth.com.

https://www.baptisthealth.com/services/heart-care/conditions/arteriosclerosis

Atherosclerosis. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-

diseases/atherosclerosis#:~:text=Atherosclerosis%20is%20thickening%20or%20hardening
Atherosclerosis Nursing Diagnosis Interventions and Care Plans. (2020, September 3). NurseStudy.net.

https://nursestudy.net/atherosclerosis-nursing-care-plans/

Belleza, M. (2016, September 28). Myocardial Infarction: Nursing Management and Study Guide. Nurseslabs.

https://nurseslabs.com/myocardial-infarction/

CDC. (2019, December 9). Coronary Artery Disease: Causes, Diagonosis & Prevention| cdc.gov. Centers for

Disease Control and Prevention. https://www.cdc.gov/heartdisease/coronary_ad.htm

Cleveland Clinic. (2015). Understanding Heart Failure | Cleveland Clinic. Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

Disseminated Intravascular Coagulation (DIC). (2018, February 26). Healthline.

https://www.healthline.com/health/disseminated-intravascular-coagulation-dic#outlook

Enlarged Heart (Cardiomegaly): Causes, Symptoms, Treatment. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/21490-enlarged-heart-cardiomegaly

Enlarged heart - Symptoms and causes. (2017). Mayo Clinic. https://www.mayoclinic.org/diseases-

conditions/enlarged-heart/symptoms-causes/syc-20355436

Heart Arrhythmia (Dysrhythmia) Signs, Symptoms & Treatment | Baptist Health. (n.d.).

Www.baptisthealth.com. https://www.baptisthealth.com/services/heart-care/conditions/dysrhythmia

Heart Failure Complications | Michigan Medicine. (n.d.). Www.uofmhealth.org.

https://www.uofmhealth.org/health-library/tx4095abc

Heart Failure: Complications | University Health Care System. (n.d.). Www.universityhealth.org.

https://www.universityhealth.org/heart-failure/complications/

Martin, P., BSN, & R.N. (2017, July 2). 4 Disseminated Intravascular Coagulation Nursing Care Plans.

Nurseslabs. https://nurseslabs.com/disseminated-intravascular-coagulation-nursing-care-plans/4/

Mayo Clinic. (2017). Heart Failure - Symptoms and Causes. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
Mayo Clinic. (2018). Arteriosclerosis / atherosclerosis - symptoms and causes. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-

20350569

Mayo Clinic. (2019, August 16). Anemia - Symptoms and causes. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360

Mayo Clinic. (2020, June 5). Coronary artery disease - Symptoms and causes. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-

20350613

Nursing Care Plan Guide for Anemia. (2016, December 7). Nurseslabs. https://nurseslabs.com/anemia-nursing-

care-plans/2/

Polycythemia: Definition, causes, symptoms, and more. (2019, December 16). Www.medicalnewstoday.com.

https://www.medicalnewstoday.com/articles/polycythemia#symptoms

STEMI Alert! Rapid Response to Acute Myocardial Infarction || NurseCE.com. (n.d.). Www.nursece.com.

https://www.nursece.com/courses/80-stemi-alert-rapid-response-to-acute-myocardial-infarction

Themes, U. F. O. (2016, July 18). Polycythemia. Nurse Key. https://nursekey.com/polycythemia/

Thrombocytopenia Nursing Diagnosis Interventions and Care Plans. (2020, November 15). NurseStudy.net.

https://nursestudy.net/thrombocytopenia-nursing-care-plans/

Vera, M., BSN, & R.N. (2013, July 13). 4 Angina Pectoris (Coronary Artery Disease) Nursing Care Plans.

Nurseslabs. https://nurseslabs.com/4-angina-coronary-artery-disease-nursing-care-plans/2/

Wayne, G. (2016, October 3). Decreased Cardiac Output – Nursing Diagnosis & Care Plan. Nurseslabs.

https://nurseslabs.com/decreased-cardiac-output/