Cardiovascular/ Respiratory

System Disease

Lecturer:
Roselily Coquilla, RN
 Cardiovascular Disorders
 The circulatory (cardiovascular) system delivers
blood to the body’s cells. Problems that occur in the
heart or blood vessels include:
 Hypertension
 Coronary artery disease (CAD)
 Angina
 Myocardial infarction
 Heart failure
 Dysrhythmias

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 Cardiovascular Disorders
 Risk Factors
 Smoking
 Unhealthy: obese or overweight
 High cholesterol
 Sedentary lifestyle
 Diabetes
 Family history

history

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 Hypertension
 With hypertension, the resting blood pressure is
too high.
• Systolic pressure = 140 mm Hg or higher; or
• Diastolic pressure = 90 mm Hg or higher
 Pre-hypertension will likely develop into
hypertension in the future.
• Systolic pressure = 120 – 139 mm Hg; or
• Diastolic pressure = 80 – 89 mm Hg
 Causes include:
• Narrowed blood vessels, kidney disorders, head injuries,
some pregnancy problems, and adrenal gland tumors.

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 Hypertension (cont’d)
 Hypertension can lead to:
• Stroke
• Hardening of the arteries
• Heart attack
• Heart failure
• Kidney failure
• Blindness

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 Hypertension (cont’d)
 Signs and Symptoms of HPN
• Headache,
• blurred vision,
• dizziness,
• nosebleeds

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 Hypertension (cont’d)
 Life-style changes can lower blood
pressure.
• A diet low in fat and salt
• A healthy weight
• Regular exercise
• Not smoking
• Limiting alcohol and caffeine
• Managing stress and sleeping well

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 Hypertension (cont’d)
 Certain drugs can lower blood pressure.
• Thiazide diuretics
• Angiotensin-converting enzyme (ACE)
inhibitors.
• Angiotensin II receptor blockers
• Calcium channel blockers.

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Overview of Cardiovascular System

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CORONARY ARTERY DISEASE
 In coronary artery disease (CAD;
coronary heart disease; heart disease),
the coronary arteries become hardened
and narrow.
• One or all of the arteries are
affected.
• The heart muscle gets less blood and
oxygen
• The most common cause is
atherosclerosis.

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 CAD (cont’d)
 The major complications of CAD are:
• Angina
• Myocardial infarction (heart attack)
• Irregular heartbeats
• Sudden death
 The more risk factors, the greater the
chance of CAD and its complications.

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 CAD (cont’d)
 CAD can be treated. Treatment goals
are to:
• Relieve symptoms.
• Slow or stop atherosclerosis.
• Lower the risk of blood clots.
• Widen or bypass clogged arteries.
• Reduce cardiac events.

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 CAD (cont’d)
 CAD requires life-style changes. The
person must:
• Quit smoking.
• Exercise.
• Reduce stress.
• Eat a healthy diet.
• If over-weight, lose weight.

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 CAD (cont’d)
 Some persons need drugs to:
• Decrease the heart’s workload
and relieve symptoms.
• Prevent a heart attack or
sudden death.
• Delay the need for medical and
surgical procedures that open or
bypass diseased arteries.

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 CAD (cont’d)
 Treatment
• Cholesterol-modifying medications (Statins)
• Aspirin
• Beta blockers - heart rate & BP
• Calcium channel blockers – improve sx of
chest pain
• Ranolazine
• Nitroglycerin
• Angiotensin-converting enzyme (ACE)
inhibitors and angiotensin II receptor
blockers (ARBs).

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 CAD (cont’d)
 CAD complications may require cardiac
rehabilitation.
• The cardiac rehab team includes:
 Doctors (the person’s doctor, heart
specialist, heart surgeon)
 Nurses
 Exercise specialists, physical and
occupational therapists, dietitians,
and mental health professionals

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 CAD (cont’d)

• Cardiac rehab has two parts.

 Exercise training
 Education, counseling, and
training

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 ANGINA
 Angina (pain) is chest pain from reduced blood flow to
part of the heart muscle (myocardium).
• It occurs when the heart needs more oxygen.
• It is described as tightness, pressure, squeezing, or
burning in the chest.
• Pain in the jaw, neck, and down one or both arms is
common
• Nausea, fatigue, and weakness
• of “gas” or indigestion.

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 ANGINA (cont’d)

 Symptoms can be relieved.

• Rest often relieves symptoms in
3 to 15 minutes.
• A nitroglycerin tablet is taken
when angina occurs.
• Some persons have nitroglycerin
patches.

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 ANGINA (cont’d)

 Things that cause angina are

avoided.
 Chest pain lasting longer than a
few minutes and not relieved by
rest and nitroglycerin may signal a
heart attack. The person needs
emergency care.

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MYOCARDIAL INFARCTION
 With myocardial
infarction (MI), part
of the heart muscle
dies.
• Sudden cardiac
death (cardiac
arrest) can occur.
 In MI, blood flow to
the heart muscle is
suddenly blocked.

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MI (cont’d)
 MI also is called:
• Heart attack
• Acute myocardial
infarction (AMI)
• Acute coronary
syndrome (ACS)
• Coronary
• Coronary thrombosis
• Coronary occlusion

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 MI (cont’d)
 Signs and symptoms
• Chest pain
 Excruciating visceral, viselike pain located at
substernal and rarely in precordial
 Usually radiates from back, shoulder, arms,
axilla, jaw and abdominal muscles (abdominal
ischemia)
 Not usually relieved by rest or by
nitroglycerine
• Mild restlessness and apprehension
• Increase in blood pressure (initial sign)

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 MI (cont’d)
 CAD, angina, and previous MI are risk factors.
 MI is an emergency.
 Efforts are made to:
• Relieve pain.
• Restore blood flow to the heart.
• Stabilize vital signs.
• Give oxygen.
• Calm the person.
• Prevent death and life-threatening problems.

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 MI (cont’d)

 The person may need:

• Balloon angioplasty
• Atherectomy: removal of plaque from the
artery
• coronary artery bypass graft.
• Cardiac rehabilitation

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CONGESTIVE HEART FAILURE (cont’d)
 Heart failure or congestive heart
failure (CHF) occurs when the
weakened heart cannot pump
normally.

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RCHF (cont’d)
 When the left side of the heart cannot
pump blood normally, blood backs up
into the lungs.
 Respiratory congestion occurs.
 The person has dyspnea, increased
sputum, cough, and gurgling sounds in
the lungs.
 .

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 RCHF (cont’d)
 When the right side of the heart cannot
pump blood normally, blood backs up into
the venous system.

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RCHF (cont’d)
 Signs and Symptoms
 Feet and ankles swell.
 Neck veins bulge.
 Liver congestion affects liver
function.
 The abdomen is congested with fluid.
 A very severe form of heart failure is
pulmonary edema (fluid in the lungs).

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 CHF (cont’d)
 Common causes of heart failure are:
• CAD
• MI
• Hypertension
• Diabetes
• Age
• Irregular heart rhythms
• Damaged heart valves
• Kidney disease

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 Cardiovascular Disorders (cont’d)
 Treatment involves:
• Drugs are ordered to strengthen the heart.
• Drugs are ordered to reduce the amount of fluid in the
body.
• A sodium-controlled diet is ordered.
• Oxygen is given.
• Semi-Fowler’s position is preferred for breathing.
• The person must reduce CAD risk factors.
• If acutely ill, the person needs hospital care.

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 CHF (cont’d)
 Drugs
• Beta blockers
• ACE inhibitors
• ARBS
• Aldosterone antagonist
• Digoxin (Lanoxin)
• Hydralazine and nitrates
• Diuretics

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 DYSRHYTHMIA
 Dysrhythmia is an abnormal heart
rhythm. The rhythm may be:
• Too fast, too slow, or irregular
 Some dysrhythmias are minor.
Others are life-threatening.

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 DYSRHYTHMIA (cont’d)
Dysrhythmias are caused by:
Changes in the heart’s electrical system
CAD, MI, or heart failure
Weakening and changes in the heart muscle
Drug and alcohol abuse
Excess caffeine intake
Thyroid problems
Some drugs

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 DYSRHYTHMIA (cont’d)
 Treatment depends on the type of dysrhythmia.
• Drugs may be given. ( E.g Lidocaine, Amiodarone)
• A procedure may be needed.
 Defibrillation or cardioversion—an electrical shock
is given to stop an abnormal rhythm
 Ablation—areas of tissue in the heart sending
abnormal electrical signals are destroyed

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 DYSRHYTHMIA (cont’d)

• Internal devices may be placed.

 Pacemaker
 Implantable cardioverter defibrillator
(ICD)

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 Respiratory Disorders

The respiratory system

brings oxygen (O2) into
the lungs and removes
carbon dioxide (CO2)
from the body.

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 Respiratory Disorders
 Respiratory disorders that interfere with this
function and threaten life include:
 Chronic obstructive pulmonary disease (COPD)
 Chronic bronchitis
 Asthma
 Sleep apnea
 Influenza
 Pneumonia
 Tuberculosis

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 Chronic Obstructive Pulmonary Disease (COPD)
 Chronic obstructive
pulmonary disease (COPD)
involves two disorders that
interfere with the exchange
of oxygen and carbon
dioxide in the lungs.
• Chronic bronchitis
• emphysema

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 COPD (cont’d)
 Risk factors for COPD include:
• Cigarette smoking; pipe, cigar, and
other tobaccos
• Exposure to second-hand smoke
 Not smoking is the best way to prevent
COPD.
 COPD has no cure.

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COPD (cont’d)
 COPD affects the airways and alveoli.
• Airways and alveoli become less
elastic.
• The walls between many alveoli
are destroyed.
• Airway walls become thick,
inflamed, and swollen.
• Airways are clogged by excess
mucus secretion.

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 COPD (cont’d)

 Chronic bronchitis occurs after

repeated episodes of bronchitis.
• Bronchitis means inflammation of
the bronchi.
 Smoking is the major cause.
 Infection, air pollution, and
industrial dusts are risk factors.

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 COPD (cont’d)

Signs and symptoms:

• Smoker’s cough in the morning is often the first
symptom.
• Chronic productive cough (lasts more than three
months)
• Shortness of Breath
• Cyanosis
• V/Q Mismatch

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Respiratory Disorders (cont’d)
 Treatment involves:
• The person must stop smoking.
• Oxygen therapy and breathing
exercises are often ordered.
• Respiratory tract infections are
prevented.
 If one occurs, the person needs
prompt treatment.

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 COPD (cont’d)
 In emphysema, the alveoli enlarge and
become less elastic.
• As a result, some air is trapped in
the alveoli when exhaling.
• Over time, more alveoli are involved;
O2 and CO2 exchange cannot occur in
affected alveoli, trapping more air in
the lungs.

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 Respiratory Disorders (cont’d)
 Smoking is the most common cause.
• Air pollution and industrial dusts are risk
factors.
 The person has shortness of breath and a
cough.
• Breathing is easier when the person sits
upright and slightly forward.

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Respiratory Disorders (cont’d)
 Treatments
• The person must stop smoking.
• Respiratory therapy, breathing
exercises, oxygen, and drug
therapy are ordered.

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 ASTHMA

 With asthma, the airway becomes

inflamed and narrow. Extra mucus is
produced.
 Signs and symptoms include:
• Dyspnea
• Wheezing and coughing
• Pain and tightness in the chest

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 ASTHMA(cont’d)

 Asthma usually is triggered by allergies.

• Other triggers include air pollutants, smoking,
second-hand smoke, respiratory infections, exertion,
cold air.
 Sudden attacks (asthma attacks) can occur.
• shortness of breath, wheezing, coughing, rapid
pulse, sweating, and cyanosis

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 ASTHMA (cont’d)

 Asthma is treated with drugs.

• Severe attacks may require emergency care.
• Repeated attacks can damage the respiratory
system.

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 SLEEP APNEA
 In sleep apnea, pauses in breathing
occur during sleep.
• Pauses last from a few seconds
to over a minute.
• They can occur many times
during sleep.

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 SLEEP APNEA (cont’d)
 The most common cause is blockage of the
airway.
• Obstructive sleep apnea—during sleep,
muscles in the throat relax and soft
tissues collapse, closing the airway.
• Central sleep apnea (less common)—
occurs when the brain does not send
signals to the muscles to breathe.

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 SLEEP APNEA (cont’d)
 Signs and symptoms of sleep apnea include:
• Pauses in breathing during sleep
• Loud snoring
• Waking during sleep with a gasp or shortness of
breath
• Difficulty staying asleep
• Daytime sleepiness
• Headache in the morning
• Dry mouth or sore throat after sleeping

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 SLEEP APNEA (cont’d)

 Treatment includes:
• Mild sleep apnea
 Life-style changes, weight loss, quitting
smoking, and avoiding alcohol and sedatives
before sleep
• More severe sleep apnea
 Surgery
 Positive airway pressure device: CPAP or
BiPAP

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 INFLUENZA
 Influenza is a respiratory infection caused
by viruses.
• Older persons are at great risk.
• Pneumonia is a common complication.

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 INFLUENZA (cont’d)

 Treatment involves:
• Fluids and rest
• Drugs ordered by the doctor for
symptom relief and to shorten the flu
episode.
 Coughing and sneezing spread flu viruses.
• Follow Standard Precautions.
 The flu vaccine is the best prevention.

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 PNEUMONIA
 Pneumonia is an inflammation and
infection of lung tissue.
• Affected tissues fill with fluid.
• O2 and CO2 exchange is affected.
 Bacteria, viruses, and other microbes
are causes.

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 PNEUMONIA(cont’d)
 Factors that increase the risk of pneumonia
include:
• Smoking
• Aging
• Stroke
• Bedrest
• Immobility
• Chronic diseases
• Tube feedings

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 PNEUMONIA(cont’d)
 Treatment may include:
• Drugs for infection and pain
• Increased fluid intake to treat fever
and to thin secretions
• Intravenous therapy and oxygen
• Semi-Fowler’s position to ease
breathing

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PULMONARY TUBERCULOSIS (PTB)
 Tuberculosis (TB) is a bacterial infection in
the lungs.
• It also can occur in other parts of the
body.
• TB is spread by airborne droplets with
coughing, sneezing, speaking, singing, or
laughing.
 Those who have close, frequent contact with
an infected person are at risk.

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PULMONARY TUBERCULOSIS (PTB)(cont’d)
 Risk factors include:
• Living in close, crowded areas
• Age
• Poor nutrition
• HIV (human immunodeficiency virus)

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PULMONARY TUBERCULOSIS (PTB)(cont’d)
 TB can be present in the body but not
cause signs and symptoms.
• Only persons with an active infection can
spread the disease to others.
 Chest x-rays and TB testing can detect the
disease.
 Signs and symptoms include:
• Tiredness, loss of appetite, weight loss,
fever, and night sweats.

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PULMONARY TUBERCULOSIS (PTB)(cont’d)
 Signs and symptoms include:
• Cough that lasts three weeks or more
• coughing up blood
• fever
• night sweats

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PULMONARY TUBERCULOSIS (PTB)(cont’d)
 Drugs for TB
• Pyrazinamide: bactericidal effect
• Ethambutol: stops the bacteria from
reproducing
• Rifampin: kills the bacteria
• Isoniazid (INH): kills the bacteria and
stops it growth
• Streptomycin

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PULMONARY TUBERCULOSIS (PTB)(cont’d)
 Treatment involves:
• Standard Precautions and Isolation
Precautions
 Hand washing after contact with sputum is
essential.

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