Acute make lifestyle changes such as loose weight, eat

Acute Myocardial
Infarction: also known as a heart attack, happens when adequate blood
flow cannot reach the heart. When blood flow is blocked for a period of time,
cell death occurs and damage to the heart muscle results. The most common
symptom is chest pain. This sensation may be described as squeezing pressure
and may run down the left arm. Women sometimes complain of different symptoms
such as shortness of breath, and fatigue. When a patient presents with chest
pain, oxygen will be administered along with nitroglycerin and morphine to
decrease pain, promote vasodilation, and decrease the amount of work the heart
needs to do. Once the patient is stable, most likely an EKG will be applied and
bloodwork with cardiac enzymes will be drawn.

Coronary Artery
Disease: is the blockage of the coronary arteries which supply
oxygenated blood to the heart. As mentioned above, when the artery is blocked
severely, a heart attack can result. CAD can be diagnosed by a stress test, or
cardiac catheterization. If the blockage is significant enough, a stent may
need to be placed to keep the artery open. Some factors that may contribute to
CAD are poor diet or exercise, increased lipids, diabetes, smoking, and
hypertension. The patient should be encouraged to make lifestyle changes such
as loose weight, eat healthier, and exercise. Information about keeping
diabetes and high blood pressure under control will also be beneficial. Patients
with CAD will most likely be prescribed nitroglycerin to take if chest pain

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Congestive Heart
Failure: is diagnosed when the heart muscle is not able to pump
adequately enough to get a sufficient amount of blood to the lungs and the rest
of the body. This can be caused by valve problems, damage to the heart muscle,
or CAD. When the left ventricle fails, the patient may complain of lethargy or
shortness of breath. Symptoms may also include crackles upon auscultation of
the lungs because the blood that is unable to be ejected to the body backs up
into the lungs. When the right side fails, the blood that cannot be ejected
into the lungs, backs up into the rest of the body causing edema, weight gain,
and enlarged organs. Right sided failure can be caused if there is an increase
in resistance causing the heart to overwork, or if the left side of the heart
has already failed. Patients should be encouraged to make lifestyle changes
such as weight loss and eating healthy to reduce the strain against the heart.
Also, medications such as ACE inhibitors, ARBs, and diuretics can also decrease
the workload of the heart.

Type I and II
Diabetes Mellitus: Glucose is “food” or energy for your body,
especially the central nervous system which thrives solely, on glucose. In
order for glucose to go inside cells to be used, insulin must bind to receptors
on these cells to make the cells permeable (or open) to glucose. When glucose
is used, the amount of glucose in the blood is lowered. Insulin is made in the
pancreas by beta cells. Glucagon is a hormone from the alpha cells of the
pancreas which causes stored insulin to be secreted when blood glucose levels
are low. Diabetes occurs when there is a problem with this balance and blood
glucose becomes too high (hyperglycemia) or too low (hypoglycemia). Type I
diabetes is the result of beta cells being destroyed causing a deficiency of
insulin. Type II diabetes can be caused from a deficiency of insulin and the
inability of the body to use insulin properly to allow glucose into cells.
Diabetes can contribute to other health issues such as: cardiovascular disease,
vision problems, neuropathy, and increased risk for stroke. All of these issues
are related to the damaging effect the extra glucose has on blood vessels. The
most common symptoms of hyperglycemia include: polyuria (increased urination),
polydipsia (excessive thirst), and polyphagia (excessive hunger). Low blood
glucose can result in dizziness, and changes in mental status. Patients with
diabetes should be well educated about how to manage blood glucose with diet
(watching carbohydrates, eating with insulin, etc..), exercise, and insulin (if

Hypertension: is
another way of saying high blood pressure. A blood pressure of 120/80 is the
desired measurement. Usually your body uses several different ways to control
blood pressure including: arterial baroreceptors which slow the heart rate and
cause vasodilation and increased voiding to decrease excessive fluid volume.
When your blood pressure is low, a substance called renin is secreted by the
kidneys. This is eventually converted to an enzyme called angiotensin II which
causes your blood vessels to constrict, and also causes aldosterone to be
secreted. Aldosterone prevents sodium in water from being lost through the
kidneys. Therefore, increased aldosterone or renin secretion (such as in kidney
disease) can also cause hypertension. Other causes can be genetics, obesity,
alcohol consumption, stress, drugs, and pregnancy. If hypertension is not
treated, it could lead to heart attack or stroke. The patient could reduce
blood pressure by avoiding excessive sodium intake, engaging in exercise, and
finding ways to relieve stress. If these methods are not enough to control
hypertension, drugs such as diuretics, calcium channel blockers, and ACE
inhibitors may be prescribed.

Acute Kidney
Injury: or kidney failure happens when there is decreased blood flow to
the kidneys, damage to the kidneys (drugs, infection, cell death), or when
there is an obstruction of urine. To identify kidney injury; I/O’s, blood
pressure, and urine appearance should be monitored frequently. Caution should
especially be used in patients taking drugs that could be toxic to the kidney’s
such as NSAIDs, and antibiotics. BUN, electrolytes, and specific gravity
abnormalities can also indicate kidney injury. If kidney injury is diagnosed, fluid
volume may increase with IV replacement or be decreased with diuretics, and
dialysis may be used to rid the blood of wastes. Kidney function can be
restored if the condition is caught and properly treated in time.

Chronic Kidney
Disease:  slowly develops over
time, but is permanent damage that cannot be reversed, only slowed. The most
common causes are hypertension or diabetes that are not well controlled. Other
causes may be disease of the tubules, infection, or other diseases of the
vascular system, kidneys or urinary tract. There are five stages of kidney
disease which is determined using a 3 or 24- hour collection of urine to
estimate the glomerular filtration rate. During stage one, the patient is
considered to be at risk for kidney disease. At the second stage (mild), kidney
function starts to decrease. During stage 3 or moderate kidney disease, wastes
start to build up in the blood. By stage 4 (severe) and 5 (end-stage) the
kidneys cannot support the body and dialysis is needed. In the later stages,
creatinine, BUN, and electrolyte lab levels are increased as the result of
decreased urine output. The patient may experience metabolic acidosis because
the body cannot get rid of enough hydrogen ions which causes the respiratory
system to try and compensate for this imbalance. Therefore, the patient may
begin to breath deeper and faster. Cardiac changes such as hypertension and
heart failure may result because of the extra workload of the heart related to
and increase in fluid volume. To treat chronic kidney disease, the patient
should be educated on how to manage the underlying cause (control diabetes or
hypertension, etc.). Diuretics and fluid restriction may be used to reduce
excess fluid volume. ACE inhibitors or calcium channel blockers can be
prescribed to control blood pressure and slow the disease. Dialysis is also
used to help rid the body of wastes.

Pneumonia: occurs
when you breath in an organism or substance that causes irritation of your
respiratory tract. This inflammation causes white blood cells to travel to the
lungs to help destroy the infection, which causes fluid build up. Because of
the fluid, the alveoli cannot expand properly which causes the patient to not
get enough oxygen. The patient may also experience flushing, fever, increased
heart rate, and may produce sputum with coughing. Some complications of
pneumonia are dehydration, sepsis, and collapsed lung. When the lungs are
auscultated crackles and possibly wheezing can be heard. If sputum is present,
a sample can be cultured to identify what is causing the infection. A chest
x-ray is usually ordered to identify the presence of fluid in the lungs.
Supplemental oxygen may be given to help resolve hypoxemia and the patient
should be educated on how to use an incentive spirometer. Bronchodilators,
steroids, and anti-infectives may be prescribed to reduce symptoms and resolve

Sepsis:   is
caused from an infection that enters the blood stream. Usually when a person
has an infection, it is confined to one part of the body. When the infection
leaves this confinement and enters the blood, systemic inflammatory response
syndrome takes place. This causes wide spread inflammation and leads to
vasodilation. The patient will experience hypotension, decreased cardiac
output, and an increased respiratory rate. If the infection progresses, cell
death and organ failure may take place. Septic shock occurs when multiple
organs fail, and bleeding begins because of decreased clot factors. Supplemental
oxygen can be given to help reduce hypoxemia, fluids and vasopressors can be
used to increase blood pressure, and broad-spectrum antibiotics are given to combat
infection. Blood may also need to be infused if patient experiences hemorrhage.

Obstructive Pulmonary Disease: consists of two conditions: emphysema
and chronic bronchitis. In emphysema, the lungs lose their elasticity because
of an excess of protease. This reduces the amount of area for gas exchange and
causes some airways to collapse. These changes also cause air to be trapped in
the lungs because the lungs over inflate and over work. The diaphragm muscle is
also weakened by the excessive work of the lungs. The patient may experience
shortness of breath and not completely exhale which causes the build up of
carbon dioxide and leads to respiratory acidosis. Chronic bronchitis occurs
when irritants are inhaled. These irritants lead to inflammation which narrows
airways and causes increased production of thick mucus. Risk factors for COPD
included smoking and asthma. Symptoms include: increased respirations, the use
of muscles of the abdomen to breath, shortness of breath with activity, barrel chest,
wheezing on auscultation and clubbing of the fingers. Arterial blood gasses,
WBC count, and sputum sample can be obtained to monitor gas exchange and
identify infection. Oxygen supplements may be used to reduce hypoxemia. The
patient can be educated on pursed lip breathing and abdominal breathing.
Coughing can also help remove secretions. Nebulizers and mucolytic medications
can be prescribed to reduce conditions.

Arterial Disease: occurs when there is blockage in an artery that
decreases the amount of blood that can flow through. The patient may complain
of pain in the leg, back, and feet with activity. Other symptoms include: hair
loss on lower extremities, dry skin, cyanosis of the extremities, decreased
pulse, and ulcers of the feet. Angiography can be performed to view blood flow
through the arteries to detect blockage. Some non-pharmacologic ways to improve
blood flow are: exercise, avoiding tight clothing, keeping extremities warm,
and avoiding smoking. The most common drug therapy are drugs that prevent
coagulation of blood such as aspirin or clopidogrel. If severe disease is
present, patients may have to go through arterial revascularization surgery to
bypass the blockages.

Vascular Disease: A blood clot can form as the result of an injury,
slowness of blood flow, if a patient’s blood clots easily.

Deep Vein
Thrombosis is a clot that most often develops in the legs, and increases
the patient’s risk for pulmonary embolism. Symptoms of a DVT usually include
redness and swelling of the leg and pain when flexing the foot. An ultrasound
can be ordered to view the blood flow in the extremity. A lab test called the
D-dimer test can also be drawn to determine if coagulation is present. Resting
the extremity is usually the most common treatment, the physician may also
recommend soaking the area in warm water. Compression hose can be worn to
increase blood flow along with elevating the legs. The patient should be told
not to massage the area; doing so may dislodge the clot. Drug therapy includes
anticoagulants such as heparin and warfarin. If non-invasive treatment does not
resolve the clot, thrombectomy may be done to remove the clot surgically.

Embolism is a medical emergency in which a dislodged clot (or any material)
travels through the body and lodges in the lungs. This can lead to decreased
perfusion throughout the body and cause death if not resolved quickly. Risk
factors include: being overweight, recent surgery, and a history of blood clots
or hypercoagulation. Symptoms include trouble breathing, chest pain when
breathing, coughing, and increased heart rate. Lab tests such as ABG’s and
D-dimer test along with a pulmonary angiography can diagnose a pulmonary
embolism. Oxygen supplementation is provided to reduce hypoxemia and
anticoagulant therapy (such as heparin) should be started to prevent additional
clotting. If anticoagulant drugs are ineffective or cannot be given an
embolectomy will be done to surgically remove the clot. Inferior vena cava
filtration can be performed to place a filter in the vena cava to catch clots
and prevent future pulmonary embolisms.

Accident (Stroke):  occurs when
there is a decrease in blood supply in the brain which can cause tissue death
and lead to disability. Ischemic stroke
occurs when a blood clot is formed in the cerebral artery or is dislodged from
another part of the body and moves to the brain. This is usually treated with
thrombolytic drugs. An embolectomy or surgical removal of the clot along with
stent placement is also an option. Hemorrhagic
stroke takes place when bleeding in the brain occurs. Bleeding can
result from trauma, or rupture of vessels from an aneurysm, arteriovenous malformation,
or high blood pressure. Bleeding can occur within the brain tissue itself, or
into the subarachnoid space.  Bleeding
and edema causes damage to the brain tissue. When bleeding occurs, the cerebral
arteries constrict which lowers blood flow even more and causes additional
damage. Surgical procedures using resection techniques, clips, and coils can be
used to isolate aneurysms and arteriovenous malformations. Risk factors for
strokes include: genetics, atherosclerosis, smoking, obesity, and cocaine use.
Symptoms of a stroke include confusion, numbness or drooping of the face,
headache, problems talking and understanding others, weakness of one side of
the body, changes in gait, and visual changes among many other possible
symptoms. A CT or MRI is usually performed to identify brain tissue damage or
interruption in blood flow to diagnose a stroke. 

Thyroid Disease:

is caused by an overproduction of thyroid hormone. This can be caused
by an auto immune disorder called Graves’ disease in which antibodies cause the
gland to grow bigger and form a goiter which causes an increase in hormone
production. Eye protrusion (exophthalmos) and swelling on the shins (pretibial
myxedema) are also symptoms of Graves’ disease. Toxic multinodular goiter can
also cause hyperthyroidism because of nodule formation on the gland. Thyroid
production can also be increased if too many replacement thyroid hormones are
used. Other symptoms include heat intolerance, vision changes, fatigue,
decreased  or absence of menstruation,
thinning of hair, and tachycardia. T3, T4, and thyroid stimulating hormone lab
tests can be performed to identify hyperthyroidism. Thyroid scans or a thyroid
ultrasound are diagnostic tests that can be ordered to assess the size of the thyroid
and the presence of any nodules. The most common drugs prescribed are
thionamides and iodine agents to decrease thyroid hormone production and
release. Surgical removal of the entire thyroid or part of the thyroid may be
necessary. If the whole thyroid is removed, the patient will be prescribe
thyroid hormone replacement.

is caused by a decreased level of thyroid hormone and can be caused by
if the thyroid is damaged, or if the patient does not take in enough iodide or
tyrosine. Symptoms include myxedema (edema caused by mucus), blank facial
expressions, thickening of the tongue, deceased heart and respiratory rate and
weight gain. Levothyroxine is the most common drug prescribed for hormone
replacement. The drug should be taken as prescribed and only changed by the
physician. The dosage is started out low and increased based on TSH levels.


Sleep Apnea: occurs when breathing is obstructed while
sleeping for at least 10 seconds. His can be caused by obesity, shortness of
the neck, tonsils that are enlarged, or edema. Not only does this effect
appropriate gas exchange, but waking up frequently prevents adequate rest. The
patient may report feeling sleeping when awakening and throughout the day and
complain of waking up several times a night. This may lead to irritability and
lethargy. Family members may report that the patient snores. A sleep study can
be preformed to assess the patient’s respirations and o2 sat while sleeping,
along with the amount of sleep they are getting. Losing weight, changing
sleeping positions, and removing enlarged tonsils may improve sleep apnea. The
patient may also be prescribed a BiPAP or a CPAP at night which will deliver
airway pressure through a mask while sleeping to keep airways open.