Cardiovascular Disorders

CARDIOVASCULAR
DISORDERS
By: Negesse Teka (BSC N, MSC
Fellow in AHN)
1
Anatomical and physiologic overview of CVS
• The heart is a hollow, muscular organ located
in the center of the thorax.
• It weighs approximately 300 g.
• Heart`s weight and size are influenced by age,
gender, body weight, extent of physical
exercise and conditioning, and heart disease.
• The heart pumps blood to the tissues,
supplying them with oxygen and nutrients.
2
Cont…
• The heart is composed of three layers

• The inner layer (endocardium) - consists of
endothelial tissue and lines the inside of the
heart and valves.
• The middle layer (myocardium) - is made up
of muscle fibers and is responsible for the
pumping action.
• The exterior layer of the heart is called the
epicardium.
3
4
Cont…
• The heart is encased in a thin, fibrous sac called the
pericardium, which is composed of two layers.
• Adhering to the epicardium is the visceral pericardium.
• Enveloping the visceral pericardium is the parietal
pericardium, a tough fibrous tissue that attaches to the
great vessels, diaphragm, sternum, and vertebral
column and supports the heart in the mediastinum.
• The space between these two layers (pericardial space)
is normally filled with about 20 ML of fluid, which
lubricates the surface of the heart and reduces friction
during systole.
5
Cont…
• The four chambers of the heart constitute the right-
and left sided pumping systems.
• The right side of the heart, made up of the right
atrium and right ventricle, distributes venous blood
(deoxygenated blood) to the lungs via the pulmonary
artery (pulmonary circulation) for oxygenation.
• The left side of the heart, composed of the left
atrium and left ventricle, distributes oxygenated
blood to the remainder of the body via the aorta
(systemic circulation).
6
Cont…
• Right atrium: collects O2 poor blood from the superior
and inferior vena cava
• Left Atrium: collect O2 rich blood from the four
pulmonary veins
• Right Ventricle: Pumps blood to the lung from right
atrium through pulmonary artery
• Left ventricle: pumps oxygen rich blood to all parts of
the body
7
Cont…
• The four valves in the heart permit blood to flow in
only one direction.
• There are two types of valves: atrioventricular and
semilunar.
ATRIOVENTRICULAR - The valves that separate the atria
from the ventricles
• Tricuspid valve - separates the right atrium from the
right ventricle.
• The mitral, or bicuspid (two cusps) valve, lies between
the left atrium and the left ventricle
8
Cont…
SEMILUNAR VALVES - the two semilunar valves are
composed of three half-moon-like leaflets.
• The valve between the right ventricle and the
pulmonary artery is called the pulmonic valve.
• The valve between the left ventricle and the aorta is
called the aortic valve.
9
Cont…
Blood supply to the heart wall
• Myocardium of the heart is a muscle with
requirement of a continuous supply of O2 and
nutrients to function with efficiency.
• The coronary arteries are responsible to supply the
above needs of the heart.
• These arteries originate from the aorta just above
the aortic valve leaflets.
10
Cont…
The Heart conduction System
► The heart pumps blood through the body
• For the heart to perform its task systematic relaxation
and contraction is required.
• During systole (contraction of the muscle), the
chambers of the heart become smaller as the blood is
ejected.
• During diastole (relaxation of the muscle), the heart
chambers fill with blood in preparation for the
subsequent ejection.
11
Cont…
• Effective contractions depends on the
electrophysiological properties of the heart muscle.
►Cardiac conduction system is the electrical
conduction system that controls the heart rate.
►This system creates the electrical impulses and
sends them throughout the heart.
12
cont…
►These impulses make the heart contract and pump
blood.
13
Cont…
The three physiologic characteristics of the cardiac
conduction cells account for this coordination
include :
1. Automaticity and rhythmicity: ability of cardiac cells
to initiate an impulse spontaneously and repetitively
with out external neuro-hormonal control.
2. Excitability: ability to respond to an electrical
impulse.
3. Conductivity: ability to transmit an electrical impulse
from one cell to another (the ability of heart muscle
fibers to propagate action potentials along and
across cell membranes.
14
Assessing cardiovascular functions
Health history
Nursing history should focus on the following areas:
• Present symptoms indicative of heart disease (e.g.
Fatigue, dyspnea, orthopnea, edema, cough, pain,
palpitations, syncope, wheezing, hemoptysis….
• Presence of problem that affect heart (e.g. Obesity,
diabetes, lung disease, endocrine disorders)
• Life style and habits that are risk factors for cardiac
disease (e.g. Smoking, alcohol intake, eating &
exercise patterns, & degree of stress perceived)
15
Assessing cardiovascular cont…
Cardiac Signs and Symptoms
Patients with cardiovascular disorders commonly
have one or more of the following signs and
symptoms:
• Chest pain or discomfort (angina pectoris, MI,
valvular heart disease)
• location? Radiation? Quality? Duration?
• What brings it on? What relieves it? Are there any
associated Symptoms, such as nausea, Vomiting,
Sweating?
16
• Shortness of breath or dyspnea
• Reduced urine output (MI, left ventricular failure)
• Edema and weight gain (right ventricular failure)
• Palpitations (dysrhythmias resulting from myocardial
ischemia, valvular heart disease, ventricular aneurysm,
stress)
• Fatigue (earliest symptom associated with several
cardiovascular disorders)
• Dizziness and syncope or loss of consciousness (postural
hypotension, dysrhythmias, cerebrovascular disorders)
17
Risk Factors in Coronary Artery Disease
• Epidemiologic Studies show that certain conditions or
behaviors are associated with a greater incidence of
coronary artery disease.
Non modifiable risk factors:
• Positive family history for heart problems
• Increasing age
• Gender(men at greater risk than premenopausal
women)
• Race (higher incidence in African –Americans than
Caucasians)
18
Modifiable risk factors:
• Elevated blood cholesterol
• Physical inactivity
• Elevated blood pressure
• Stress
• Cigarette smoking
• Use of oral contraceptives
• Elevated blood glucose
• Obesity…….
19
Physical Assessment
• Assessing for physical finding is performed to
confirm data obtained in the health history.
• General appearance (alert, lethargic, stuporous,
comatose) and mental status (oriented to person,
place, time; coherence).
- Signs of distress, which include pain or discomfort,
shortness of breath, or anxiety.
Examination of Blood pressure
- The normal adult blood pressure value ranges
from 90/60 to 140/90mmHg
20
Pulse pressure
• It is the difference between the systolic and the
diastolic pressure and is approximately 40mmHg
Pulse rate
• The normal pulse rate varies from a low of 50 in
healthy, athletic, young adults to 100 after exercise
or during times of excitement
Pulse rhythm
• Disturbances in pulse rhythm (dysrhythmias) often
result in a pulse deficit (a difference between the
apical rate and the peripheral rate)
21
Pulse volume (amplitude)

Carotid artery is the
best.
Don’t palpate both
carotids
simultaneously
22
Hands
• Peripheral cyanosis – a bluish discoloration of the
skin – implies decreased blood flow in the
periphery as incase of carcinogenic shock
• Pallor – can indicate anemia
• Capillary refill time – should not take more than 2
seconds
23
• Edema stretches the skin and make it less flexible
• Clubbing of the fingers and toes implies chronic
hemoglobin desaturation, as in congenital heart disease
• Reduced skin turgor occurs with dehydration
Head and Neck
• Assess the lips and earlobes for peripheral cyanosis
• Jugular vein distension indicates an abnormal increase
in the volume of the venous system (right sided cardiac
failure, Valvular stenosis, Pulmonary embolism)
24
Heart
• Examination of the chest wall is performed in the
following six areas:
• Aortic area- 2nd ICS to the right of the sternum
• Pulmonic area 2nd ICS to the left of the sternum
• Erb's point 3rd ICS to the left of the sternum
• Tricuspid area 4th - 5th ICS to the left of the sternum
• Apical area 5th ICS to the left of the sternum mid
clavicular
• Epigastric area below the Xiphoid process.
25
26
Inspection and Palpation
• There is a normal pulse that is distinct and well
localized directly over the apex of heart.
• It is called apical pulse or point of maximal impulse
(PMI) and is often palpable and may be observed in
younger persons and in older persons who are thin.
N.B: If the PMI is below the 5th ICS or lateral to the

midclavicular line, it is abnormal and the cause is left
ventricular failure.
27
Percussion
• Normally, the left border of the heart is detected by
percussion
Auscultation
• All areas, except the Epigastric area, are auscultated
• First heart sound (S1) “lub” is best heard with the
diaphragm. It is created by the simultaneous closure of
the mitral and tricuspid valves.
• Second heart sound (S2) “dub” is produced by the
closing of the aortic and pulmonic valves
28
29
Common diagnostic procedures and nursing responsibilities
ECG (electro cardiograph)

• It is a graphic recording of the electrical activity of
the heart.
• It is a reflection of the electrical activity that starts
from SA node and cause the heart to contract
Lab tests
Blood chemistry
• Lipid profile – cholesterol, triglycerides, and
lipoproteins are measured to evaluate a person risk
for developing atherosclerotic disease.
30
Common diagnostic procedures cont…
• Cholesterol and triglycerides are transported in the
blood by combining with protein molecules to form
lipoproteins.
• The risk of CAD increases as the ratio of LDL to HDL
• Cholesterol levels: Cholesterol is a lipid required for
hormone synthesis and cell membrane formation.
Normal level is less than 200 mg/dl: increased level is
known to increase risk for CAD (coronary artery
disease).
• Serum electrolyte level – sodium, potassium and
calcium are ions that are vital to cellular function of
the heart.
31
• Hypokalemia increases the risk of cardiac electrical
instability, the occurrence of ventricular dysrhythmias,
& the risk of digitalis toxicity.
• It is caused by diuretic therapy, vomiting, diarrhea &
alkalosis.
• Hyponatremia => seen with heart failure, stress,
excessive IV infusion of hypotonic fluids.
• Hypocalcaemia => results from renal failure and
alkalosis can lead to serious ventricular dysrhythmias.
32
• BUN: increased level may be indicative of decreased
renal perfusion as a result of a cardiac disease (from
decreased COP)
• Serum glucose level – is important to monitor as many
patients with cardiac disease also have diabetes
mellitus
• Hematological testing
Hemoglobin and hematocrite – should be monitored in
patients with coronary artery disease as there
decreased level has serous consequences like frequent
episode of Angina.
33
Chest x ray
• Usually obtained to determine Size, contour and
position of the heart
• Pulmonary congestion from heart failure
Coronary angiography
• A radiopaque material injected into coronary arteries.
It allows visualization of coronary arterial narrowing
or occlusion.
34
Echocardiography: It is a noninvasive ultrasound test that is
used to examine the size, shape, and motion of cardiac
structures.
• It is used to help & diagnose: Pericardial effusion, Valvular
disorders, Cardiac tumors etc
Cardiac enzymes: are cellular proteins released in to the
blood as a result of cell membrane injury.
Their presence in the blood confirms acute myocardial
infarction or severe cardiac damage.
- Myoglobin => useful marker of myocardial necrosis.
- Creatine kinase (ck) and lactic acid dehydrogenase (LDH)
serum elevation reveals myocardial damage.
35
Blood coagulation tests
Used to examine the ability of blood to clot.
• Prothrombine time (PT) (the time required for a
particular specimen of Prothrombine to induce
blood-plasma clotting under standardized
conditions.
• A normal PT is between 11.5 and 12 seconds for
normal human blood.
36
Coronary vascular disorders
CORONARY ARTERY DISEASE (CAD)
• It is a narrowing of the coronary arteries that prevents
adequate blood supply to the heart muscle.
• It usually caused by atherosclerosis, it may progress to
the point where the heart muscle is damaged due to
lack of blood supply.
• Such damage may result in infarction, arrhythmias, and
heart failure.
• Coronary artery disease (CAD) is the most prevalent
type of cardiovascular disease in adults.
37
Risk factors
38
Coronary Atherosclerosis cont.…..
Clinical Manifestations
• CAD produces symptoms and complications according to the
location and degree of narrowing of the arterial lumen,
thrombus formation, and obstruction of blood flow to the
myocardium.
• The most common manifestation of myocardial ischemia is
the onset of chest pain or discomfort (angina).
• The pain may radiate to neck, arms, stomach, or upper back.
• The pain usually occurs with activity or emotion, and goes
away with rest.
• Asymptomatic, Shortness of breath, Weakness….
39
Diagnosis
Electrocardiograms (ECG)
• Provide a record of the heart's electrical activity.
This simple test records any abnormal findings in the heart's
electrical impulses.
Echocardiograms (ECHOs)
• It is a test that uses sound waves to create pictures of the
heart.
• Shows a problem with the heart muscle or one of the valves
that channel blood through the heart.
40
Stress tests
• They are used to show how the heart reacts to physical
exertion. Exercise stress tests are usually performed on
exercise bicycle.
Angiography
• Is the most accurate means by which to examine the
coronary arteries.
• It requires a surgical procedure called cardiac catheterization.
• During the procedure, catheters are placed in the artery of
the leg or arm, and directed using an x-ray machine to the
opening of each of the coronary arteries.
41
Treatment
Lifestyle changes
• Weight control
• Smoking cessation
• Exercise
• Healthy diet
42
Medications to treat coronary disease
• Cholesterol lowering medications, such as statins, are
useful to decrease the amount of "bad" (LDL)
cholesterol.
• Nitroglycerin
• ACE inhibitors, which treat hypertension and may lower
the risk of recurrent myocardial infarction
• Calcium channel blockers
• Aspirin
43
Surgical intervention
• Angioplasty
• Stents
• Coronary artery bypass grafting (CABG)
44
Angina Pectoris
• It is a clinical syndrome
usually characterized by
episodes or paroxysms
of pain or pressure in
the anterior chest.
45
Angina Pectoris cont.…
• The cause is insufficient coronary blood flow,
resulting in a decreased oxygen supply when there is
increased myocardial demand for oxygen in response
to physical exertion or emotional stress.
• In other words, the need for oxygen exceeds the
supply.
• In general, the severity of the symptoms of angina is
based on the magnitude of the precipitating activity
and its effect on activities of daily living.
46
Types of Angina
• Stable angina: predictable and consistent pain that
occurs on exertion and is relieved by rest and/or
nitroglycerin
• Unstable angina (also called preinfarction angina or
crescendo angina): symptoms increase in frequency and
severity; may not be relieved with rest or nitroglycerin.
• Intractable or refractory angina: severe incapacitating
chest pain.
47
Factors are associated with typical anginal pain
• Physical exertion, which can precipitate an attack by
increasing myocardial oxygen demand
• Exposure to cold, which can cause vasoconstriction and
elevated blood pressure, with increased oxygen
demand.
• Eating a heavy meal, which increases the blood flow to
the mesenteric area for digestion, thereby reducing the
blood supply available to the heart muscle.
48
• Stress or any emotion-provoking situation, causing the
release of Catecholamines, which increases blood
pressure, heart rate, and myocardial workload.
• Unstable angina is not associated with these listed
factors. It may occur at rest.
49
Clinical manifestation
• Chest pain that ranges from discomfort to agonizing
pain accompanied by severe fear and a feeling of
impending death.
• The pain is often felt deep in the chest behind the
sternum
• The pain may radiate to the neck, jaw, shoulders, and
inner aspects of the upper arms.
50
• A feeling of weakness or numbness in the arms, wrists,
and hands, as well as shortness of breath, pallor,
diaphoresis, dizziness or lightheadedness, and nausea
and vomiting may accompany the pain.
• Anxiety may occur with angina.
• An important characteristic of angina is that it subsides
with rest or administering nitroglycerin.
51
Assessment and Diagnostic Findings
• History
• Electrocardiogram (ECG)
• Exercise stress test
Management
• Decrease the oxygen demand of the myocardium and to
increase the oxygen supply.
• Pharmacologic therapy and control of risk factors.
52
• Nitroglycerin: is administered to reduce myocardial
oxygen consumption by dilates primarily the veins and,
in higher doses, the arteries.
• Beta-Adrenergic Blocking Agents (metoprolol): reduce
myocardial oxygen consumption by blocking beta-
adrenergic sympathetic stimulation to the heart.
• Calcium Channel Blocking Agents (diltiazem): slower
heart rate and a decrease in the strength of myocardial
contraction.
• Antiplatelet and Anticoagulant Medications (Aspirin,
Heparin): Antiplatelet medications are administered
to prevent platelet aggregation and subsequent
thrombosis, which impedes blood flow.
• Oxygen Administration: is usually initiated at the
onset of chest pain in an attempt to increase the
amount of oxygen delivered to the myocardium and
to decrease pain.
54
Myocardial Infarction
• Myocardial infarction (MI) or acute myocardial
infarction (AMI), commonly known as a heart attack, is
the interruption of blood supply to part of the heart,
causing some heart cells to die.
Pathophysiology
MI refers to the process by which areas of myocardial
cells in the heart are permanently destroyed.
55
Myocardial Infarction cont.…
• Like unstable angina, MI is usually caused by reduced
blood flow in a coronary artery due to atherosclerosis
and occlusion of an artery by an embolus or thrombus.
• Other causes of an MI include vasospasm (sudden
constriction or narrowing) of a coronary artery;
decreased oxygen supply (e.g. from acute blood loss,
anemia, or low blood pressure); and increased demand
for oxygen (e.g. from a rapid heart rate, thyrotoxicosis,
or ingestion of cocaine).
• In each case, a profound imbalance exists between
myocardial oxygen supply and demand.
56
• MIs most often result in damage to the left ventricle,
leading to an alteration in left ventricular function.
• Infarctions can also occur in the right ventricle or in
both ventricles.
• The area of infarction takes time to develop.
• As the cells are deprived of oxygen, ischemia develops,
cellular injury occurs, and over time, the lack of oxygen
results in infarction, or the death of cells.
57
Clinical Manifestations
• Chest pain that occurs suddenly and continues despite
rest and medication is the presenting symptom in most
patients with an MI.
• Patients may also be anxious and restless.
• They may have cool, pale, and moist skin.
• Their heart rate and respiratory rate may be faster than
normal.
58
• Patient history: The patient history has two parts: the
description of the presenting symptom (e.g. pain) and
the history of previous illnesses and family health
history, particularly of heart disease. Previous history
should also include information about the patient’s risk
factors for heart disease.
• Electrocardiogram
• Laboratory test results (e.g. serial serum enzyme
values). E.G. Creatine Kinase and Myoglobin
59
Medical Management
• Thrombolytic (streptokinases), analgesic (morphine
sulfate) and angiotensin-converting enzyme (ACE)
inhibitors (decreasing the oxygen demand of the heart).
• Minimizing myocardial damage is also accomplished by
reducing myocardial oxygen demand and increasing
oxygen supply with medications, oxygen administration,
and bed rest.
• Aspirin, heparin, nitroglycerin, an IV beta-blocker.
60
Vascular Disorders
01/03/2023 61
Hypertension
On completion of this session the learner will be able to:

 Define Hypertension and categories of abnormal pressures.
 Identify risk factors for hypertension.
 Describe treatment approaches for hypertension, including lifestyle
modifications and medication therapy.
 Use the nursing process as a framework for care of the patient with
hypertension.
 Describe hypertensive crises and their treatment
01/03/2023 62
Hypertension…….
• Systemic arterial BP is the pressure exerted on the walls of the

arteries during ventricular systole and diastole.
• It is affected by factors such as cardiac output, distention of the
arteries; and the volume, velocity, and viscosity of the blood.
• The mean arterial pressure is an average blood pressure over the
course of one cardiac cycle.
• Pulse pressure: the difference between systolic and diastolic
pressure
01/03/2023 63
Hypertension…….
 A normal BP in adults is considered a systolic BP less than 120

mm Hg and a diastolic BP less than 80 mm Hg.
 High BP, called hypertension, is defined by having a systolic BP
that is consistently greater than 140 mm Hg or a diastolic BP
greater than 90 mm Hg.
 Hypotension refers to an abnormally low systolic and diastolic
BP that can result in lightheadedness or fainting
 BP =CO X SVR
 CO=HR X SV
01/03/2023 64
Hypertension
• HPN is a amount of resistance of blood pumping through

body/arteries.
• It is when systolic B/P  140 mm Hg and a diastolic pressure  90

mm Hg over a sustained period, based on the average of two or more
blood pressure measurements taken in two or more contacts with the
health care provider after an initial screening.
01/03/2023 65
Hypertension…
• Blood pressure is proportional to peripheral vascular
resistance.
• Hypertension is often referred to as "the silent
killer," as it can quietly causes damage to the
cardiovascular system.
• It affect major organ systems such as cardiovascular
system (chf ) , brain (stroke ), kidney (renal
failure) and eye (retinal change )
01/03/2023 66
Blood Pressure Classification/stages
• Classification of Blood Pressure for Adults Age 18 and Olders

• BP Classification SBP mmHg DBP mmHg
• Normal < 120 < 80
• Pre-hypertension 120-139 80-89
• Stage 1 HTN 140-159 90-99
• Stage 2 HTN  160  100
01/03/2023 67
Clinical manifestations
• People with hypertension can be asymptomatic and remain so for

many years.
• However, when specific signs and symptoms appear, they usually

indicate vascular damage, with specific manifestations related to the
organs served by the involved vessels
Coronary artery disease with angina or myocardial infarction is a

common consequence of hypertension.
01/03/2023 68
• Left ventricular hypertrophy occurs in response to the increased
workload placed on the ventricle as it contracts against higher
systemic pressure.
• When heart damage is extensive, heart failure ensues.
• Pathologic changes in the kidneys (indicated by increased [BUN] and

creatinine levels) may manifest as nocturia.
01/03/2023 69
• Cerebrovascular involvement may lead to a stroke or transient
ischemic attack (TIA), manifested by alterations in vision or speech,
dizziness, weakness, a sudden fall, or temporary paralysis on one side
(hemiplegia)
• Cerebral infarctions account for most of the strokes and TIAs in

patients with hypertension.
01/03/2023 70
Assessment and Diagnostic Evaluation
Health history and physical examination

The retinas are examined
Routine laboratory tests include urinalysis, blood
chemistry (i.e., sodium, potassium, creatinine, fasting
glucose, and cholesterol levels).
Electrocardiogram.
Echocardiography: Left ventricular hypertrophy can
be assessed
Renal damage :elevations in BUN and creatinine
levels
01/03/2023 71
Medical Management
The goal of hypertension treatment is to prevent death and

complications by achieving and maintaining the arterial blood pressure at
140/90 mm Hg or lower
The optimal management plan is inexpensive, simple, and causes the

least possible disruption in the patient’s life.
01/03/2023 72
Pharmacologic Therapy
• For patients with uncomplicated hypertension and no specific indications

for another medication, the recommended initial medications include
diuretics, beta-blockers, or both
• Patients are first given low doses of medication.
01/03/2023 73
• If blood pressure does not fall to less than 140/90 mm Hg, the dose
is increased gradually, and additional medications are included as
necessary to achieve control
• When the blood pressure has been less than 140/90 mm Hg for at
least 1 year, gradual reduction of the types and doses of medication
is recommended.
01/03/2023 74
Diuretics
 Low-dose thiazide diuretics often are used as first-line agents alone or in
combination with other antihypertensive drugs.
 Thiazides inhibit the Na+/Cl– pump in the distal convoluted tubule and
hence increase sodium excretion.
 They provide additive blood pressure lowering effects when combined with
beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), or
angiotensin receptor blockers (ARBs).
 Eg. Hydrochlorothiazide
01/03/2023 75
Adrenergic Inhibitors:
Reduce sympathetic effects that cause HTN by:
Reducing sympathetic outflow

Blocking effects of sympathetic activity on
vessels
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Calcium Channel Blockers
 Block movement of calcium into cells, causing vasodilatation.
 Calcium antagonists reduce vascular resistance through L-channel blockade,

which reduces intracellular calcium and blunts vasoconstriction.
 Eg. Nifedipine
01/03/2023 77
Lifestyle Modifications for HPN Prevention and Mgt
• Lose weight if overweight
• Limit alcohol intake
• Increase aerobic physical activity
• Reduce sodium intake to no more than 100 mmol per day
• Maintain adequate intake of dietary potassium
• Maintain adequate intake of dietary calcium and magnesium for general

health.
• Stop smoking and reduce intake of dietary saturated fat and cholesterol
for overall cardiovascular health
01/03/2023 78
Compications of untreated
hypertension
• Coronary artery disease (angina or MI)
• Left ventricular hypertrophy
• HF
• Renal failure
• Cerebrovascular involvement [stroke or transient ischemic attack
(TIA)]
• Impaired vision
01/03/2023 79
Hypertensive crisis
 Severely elevated blood pressure (equal to or greater than a systolic 180
or diastolic of 120) is referred to as a hypertensive crisis.
 Two major forms:
 A. Hypertensive emergencies
Is characterized sever elevation of SBP, > 180 ,

DBP > 120 mm Hg.
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Hypertensive emergencies……..
• There is one or more organ system damages like:
Cardio vascular ischemia

renal failure
pulmonary edema
• It needs immediate blood pressure reduction to
stop or prevent target organ damage.
01/03/2023 81
Treatment of Hypertensive Emergencies
• Optimal therapy varies with the type of hypertensive emergency.
• Hydralazine, 5-10 mg initial dose, repeated every 20 to 30 minutes

(with maximum dose of 20 mg) should be given until the mean
arterial blood pressure is reduced by 25% (within minutes to 2 hours),
then towards 160/100 mm Hg within 2-6 hours.
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B. Hypertensive urgencies
There is asymptomatic sever hypertension with

no target organ damage.
Elevated blood pressures associated with severe
headaches, nosebleeds, or anxiety are classified
as urgencies.
In these situations oral agents can be
administered with the goal of normalizing blood
pressure within 24 to 48 hours
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Treatment of Hypertensive Urgency
•For previously treated patients-adjust existing medication

regimen, or reinstitute medications (if nonadherent).
• For previously untreated patients – start either a low
dose of a calcium channel blocker (Nifedipine) or ACE
inhibitor (captopril or Enalapril) or Beta blocker
•Furosemide 20-40mg (PO or IV) can be added to the above
agents
•Avoid rapid drop in blood pressure
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Discharge instructions
Provide written information : expected effects and side effects of

medications; report s/e
Rebound hypertension
Sexual dysfunction some medications, such as beta-blockers, may
cause sexual dysfunction and that, if a problem with sexual function
or satisfaction occurs, other medications are available.
Monitor BP at home.
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Nursing care for hypertensive crisis
• Extremely close hemodynamic monitoring of the patient’s blood

pressure and cardiovascular status is required during treatment of
hypertensive emergencies and urgencies. hypertensive emergencies
and urgencies.
• Vital Sign every 5 minutes or 15 or 30 minutes intervals if stable.
• A precipitous drop in blood pressure can occur, which would require
immediate action to restore blood pressure to an acceptable level.
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Hypotension
• ↓ BP is called Hypotension (Below 90/60 mm of Hg)

• Types of low blood pressure
• Orthostatic or postural hypotension: sudden drop in BP when you
stand up from a sitting position or after lying down
• Postprandial Hypotension; drop in BP 1 to 2 hr after eating
• Neurally mediated hypotension ; miscommuication of heart and
brain
• Low BP due to nervous system damage; progressive damage to ANS
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Causes of hypotension
Dehydration
 Vomiting
Diarrhea
Burn
Adison's disease
Hypothyroidism
Hemorrhage
Pregnancy
Antihypertensive drugs
01/03/2023 88
Clinical manifestation
• Dizziness
• Visual changes
• Head and neck discomfort Poor concentration while standing
• Poor concentration while standing
• Palpitations
• Tremor, anxiety
• Presyncope, and in some cases syncope
01/03/2023 89
Rapid and shallow Respirations, Crackles

As blood flow to the brain is impaired, mental status. Initially, change
in behavior or confusion.
Subsequently, lethargy increases & lose consciousness.
Decreased blood flow also impairs the ability of liver cells to perform
metabolic and phagocytic functions.
01/03/2023 90
Management of hypotension
Major goals in treating hypotension are :
I. Restore intravascular volume to reverse the sequence of events

leading to inadequate tissue perfusion.
II. Redistribute fluid volume.
III. Correct the underlying cause of the fluid loss as quickly as

possible
01/03/2023 91
Management of hypotension………
A. Treatment of the underlying cause
B. Fluid replacement to restore intravascular

volume.
C. Vasoactive medications to restore vasomotor tone

and improve cardiac function
D. Nutritional support to address the metabolic

requirements
01/03/2023 92
A. Treatment of the underlying cause
If the patient is hemorrhaging, efforts are made to stop the bleeding.
This may involve applying pressure to the bleeding site or surgery to

stop internal bleeding.
If the cause of the hypovolemia is diarrhea or vomiting, treat diarrhea

and vomiting.
01/03/2023 93
B. Fluid replacement
• The type of fluids administered and the speed of delivery vary, but
fluids are given to improve cardiac and tissue oxygenation, which in
part depends on flow.
• The fluids administered may include
 crystalloids (0.9% N/S,RL),
 colloids (blood).
01/03/2023 94
Fluid Management ….
01/03/2023 95
C. Vasoconstrictive medication
theraphy
• Vasoactive medications are administered to improve the patient’s
hemodynamic stability when fluid therapy alone cannot maintain adequate
MAP.
These medications help to:
Increase the strength of myocardial contractility.
Regulate the heart rate
Reduce myocardial resistance
Initiate vasoconstriction
 eg. Norepinephrine
01/03/2023 96
D. Nutritional support
Nutritional support is an important aspect of care for the patient with

Hypotension
 Increased metabolic rates during hypotension increase energy
requirements and therefore caloric requirements
The release of catecholamines early in the hypotension causes
glycogen stores to be depleted in about 8 to 10 hours
 Nutritional energy requirements are then met by breaking down lean
body mass.
01/03/2023 97
Diseases of vein
• Learning objectives: at the end of this session the student will be
able :
• Define of thrombophlebitis ,varicose vein and embolism
• Identifying cinical manifestation of venous disorders
• Identify the appropraite diagnostic strategy for venous disorders
• Explain pharmacologic and nursing management of venous disorders
01/03/2023 98
Venous Disorders
a) Venous Thrombosis
 Deep Vein Thrombosis (DVT),
 Thrombophlebitis
 Phlebothrombosis
b) Chronic Venous Insufficiency
C) Leg Ulcers
D) Varicose Veins
01/03/2023 99
Venous Thrombosis
Is a blood clot (thrombus) that forms within a vein

Can occur in any vein; common in lower extremities.
Superficial and deep veins of the extremities may be affected
Types of venous thrombosis
Thrombophlebitis
Phlebothrombosis
Phlebitis
01/03/2023 100
Venous Thrombosis ...
• Thrombophlebitis
Thrombus that is associated with inflammation
Most frequently occurs in deep veins of lower extremities.
• Deep vein thrombophlebitis is commonly referred to as deep vein
thrombosis (DVT)
More serious than superficial thrombophlebitis because it presents
a greater risk for pulmonary embolism (PE).
01/03/2023 101
Venous Thrombosis ...
Risk factors for thromboplebitis

Inactivity : recent injury, surgery , prolonged sitting, recent travel
Pregnancy or recent child birth
OCP use or estrogen theraphy
Cancer
Familial clotting disorders (thrombophilia)
Centeral venous catheter
01/03/2023 102
Venous Thrombosis….
 develops in both the deep and superficial veins of the lower
extremity
 deep veins – femoral, popliteal, small calf veins
 superficial veins – saphenous vein
 Thrombus – form in the veins from accumulation of platelets,
fibrin, WBC and RBC
01/03/2023 103
Venous Thrombosis……
• Phlebothrombosis: thrombus without inflammation.

• Thrombus develops initially in veins as result of stasis or
hypercoagulability but without inflammation
• Phlebitis: vein inflammation associated with invasive procedures (IV
therapy), surgery
01/03/2023 104
Deep Vein Thrombosis (DVT)
• Thrombosis: formation or presence of a thrombus, e.g. thrombosis of

cerebral vessels, thrombosis of coronary artery.
• Thrombus: an aggregation of blood factors, primarily platelet and
fibrin with entrapment of cellular element, frequently causing
vascular obstruction at the point of its formation.
• Embolus: a clot or other plug brought by blood from another vessel
and forced in to a smaller one, thus obstructing the circulation.
01/03/2023 105
Risk Factors for Deep Vein Thrombosis
(DVT)
Virchow’s Triad
• Stasis of venous circulation
• Hypercoagulability
• Endothelial damage (vascular wall injury)
01/03/2023 106
History and physical examination
Doppler ultrasound of leg and pelvic veins
MRI
Blood laboratory studies
Homans' sign has been used historically to assess for DVT.
01/03/2023 107
DVT Complications
• Chronic venous insufficiency and
• Pulmonary embolism
01/03/2023 108
Medical Management
• The objectives of treatment for deep vein thrombosis are to prevent

the thrombus from growing and fragmenting and to prevent recurrent
thromboembolism.
• Anticoagulant therapy (administration of a medication to delay the

clotting time of blood, prevent the formation of a thrombus in
postoperative patients.
01/03/2023 109
Medical Management
• Unfractionated heparin is administered subcutaneously to prevent

development of DVT, or by intermittent or continuous IV infusion for
5 to 7 days to prevent the extension of a thrombus and the
development of new thrombi.
• Oral anticoagulants, such as warfarin (Coumadin), are administered

with heparin therapy. Warfarin is contra indicated for pregnant
women
01/03/2023 110
Medical Management
• Thrombolytic therapy: is given within the first 3 days after acute

thrombosis.
• Surgery is necessary for DVT when anticoagulant or thrombolytic

therapy is contraindicated
01/03/2023 111
Nursing management
Assess patients readiness to learn, misconceptions , and block to

learning
Educate patient about anticoagulation theraphy
Elastic compression stockings.
Early ambulation after proper anticoagulation
01/03/2023 112
EMBOLISM
• Process of partial or complete obstruction of some part of the
cardiovascular system by any mass carried in the circulation.
• An embolus is detached intravascular solid, liquid, or gaseous
mass that is carried by the blood to a site distant from its point of
origin
• emboli (90%) are thromboemboli
• a moving blood clot is called a

thromboembolus
01/03/2023 113
Thanks !
01/03/2023 114
Heart Failure
115
Definition
• CHF a state in which the heart is unable to pump an

adequate amount of blood to meet the metabolic needs
of the tissue.
• Heart failure as a complex clinical syndrome that results

from structural or functional impairment of ventricular
ejection of blood or filling, which in turn leads to the
cardinal clinical symptoms of dyspnea, fatigue and
other signs of HF.
116
Etiology

Disease of myocardium
IHD
toxic damage
Genetic abnormalities
Metabolic derangements
Immune-mediated and inflammatory damage and
infiltration

Abnormal loading conditions
HTN and CAD
Valve and myocardium structural defects
Pericardial and end-myocardial pathologies
High output states
Volume overload

Arrhythmias
Tachyarrhythmia or Bradyarrhythmias 117
Classification
• Based on contractility
Systolic HF: is the inability of the ventricles to contract
normally and expel sufficient blood
Diastolic HF: inability of the ventricles to relax and/or
fill normally.
Based on affected side
Right side HF: results from weakened right ventricle
causes venous congestion in the systemic circulation &
results in peripheral edema, hepatomegaly &
splenomegaly.
Left side HF : results from left ventricular dysfunction,
which causes blood to back-up through the left atrium
and into the pulmonary veins, then results in pulmonary
congestion and edema.
Classification based on severity of symptoms
The New York Heart Association (NYHA) (I, II, III, IV) 118
119
Many clinical manifestations associated with HF is the signs

and symptoms that related to congestion and poor perfusion.
The signs and symptoms of HF can also be related to the
ventricle that is most affected side.
Symptom that related to congestion are
 Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea
 Cough , Pulmonary crackles that do not clear with cough
 Weight gain (rapid), Dependent edema, Ascites
 Jugular venous distention and Exophthalmos
 Fatigue
 sleep disturbance (anxiety or air hunger)
120
Clinical manifestations….
Symptom that related to poor perfusion/Low

cardiac output
Decreased exercise tolerance
Unexplained weight loss
Lightheadedness or dizziness
Altered mental status/confusion
Resting tachycardia
Daytime oliguria with recumbent nocturia
Pallor or cyanosis
Cool extremities
121
Symptom that related to left side heart failure
 Pulmonary edema, Pulmonary congestion
 Pleural effusion, Alveolar congestion, Pitting edema ,
Tachycardia , Left ventricular hypertrophy, Slight hypercapnea
 Dyspnea (shallow, rapid respiration up to 32-40/min)
 Dyspnea on exertion [DOE]) and orthopnea
 Cough (dry, caused by alveolar irritation from fluid
accumulation) and pulmonary crackles
 Low oxygen saturation levels
 Extra heart sound, the S3, or “ventricular gallop”
 Difficulty sleeping
 Oliguria at the day and nocturia at the night
 Dizziness, lightheadedness, confusion, restlessness, and anxiety
 Orthopnea
 Paroxysmal nocturnal dyspnea
122
Symptom that related to Right side heart failure
• Hepatomegaly
• Ascites
• Edema of dependent body parts – dependent edema (sacrum,
anterior tibias, pedal edema)
• Anasarca (generalized massive body edema)
• Jugular vein distention
• Splenomegaly
• Weight gain due to retention of fluid.
 Anorexia (loss of appetite), nausea, or abdominal pain
123
124
Diagnosis
• Clinical HX & PE
• Chest x-ray: the main findings are cardiomegaly, pulmonary
edema, and pleural effusion.
Echocardiography: may help identify valvular
abnormalities, ventricular dysfunction, cardiac temponade,
pericardial constriction, EF and pulmonary embolus.
Electrocardiogram (ECG): is a nonspecific tool but may be
useful in diagnosing concomitant cardiac ischemia, prior
myocardial infarction (MI), cardiac dysrhythmias, chronic
hypertension, and other causes of left ventricular hypertrophy.
Other laboratory tests : Hemoglobin, Urinalysis, BUN,
Creatinine, CBC, lipid profile test, exercise test, thyroid
stimulating hormone (TSH) level, BNP level, serum
electrolyte
125
Management
• The goals of management of HF are to relieve
patient symptoms, to improve functional status and
quality of life, and to extend survival.
• Specific interventions are based on the stage of HF.
• Treatment options vary according to the severity HF
Oral and intravenous (IV) medications
Supplemental oxygen
Surgical interventions including implantation of
cardiac devices and cardiac transplantation
Major lifestyle changes
126
Treatment Approach
1. Stage I
Treat hypertension and Add ACEI especially in
hypertension
Encourage smoking cessation
Treat lipid disorders
Encourage regular exercise
Discourage alcohol intake and illicit drug use
2. Stage II
All measures under Stage I
Add beta-blocker: primarily by decreasing
cardiac output (through reducing rate and
force of myocardium contraction).
127
Treatment Approach….
3. Stage III
 All measures under stages A and B
 Add diuretic
 Add digitalis in systolic HF
 Add spironolactone
 Restrict dietary salt to <2 g/d (eliminate salt-rich foods
and added salt in cooking or at table)
4. Stage IV
 All measures under Stages A, B, and C
 Dietary salt restriction to <1 g/d
 Mechanical assist devices
 Heart transplantation
 Continuous intravenous inotropic infusions for
palliation (does not prolong life)
128
Pharmacologic therapy
• Diuretics, which reduce edema by reduction of blood volume and
venous pressures
• Vasodilators, for preload and afterload reduction
• Inotropic agents, which help to restore organ perfusion and reduce
congestion
• Anticoagulants, to decrease the risk of thromboembolism
• Beta-blockers, for neurohormonal modification, left
ventricular ejection fraction (LVEF) improvement, arrhythmia
prevention, and ventricular rate control.
• Angiotensin-converting enzyme inhibitors (ACEIs), for
neurohormonal modification, vasodilatation, and LVEF
improvement.
• Angiotensin II receptor blockers (ARBs), also for
neurohormonal modification, vasodilatation, and LVEF
improvement
• Analgesics, for pain management. 129
Drugs that can exacerbate heart failure
• Avoided, such as nonsteroidal anti-inflammatory

drugs (NSAIDs), calcium channel blockers (CCBs),
and most antiarrhythmic drugs (except class III).
• Generally, calcium channel blockers (CCBs) should
be avoided.
• CCBs do not play a direct role in the management of
heart failure; however, these agents may be used to
treat other conditions, such as hypertension or
angina in some heart failure patients.
130
Surgical management
• A number of procedures and surgical approaches may

benefit patients with HF. If the patient has underlying
coronary artery disease, coronary artery
revascularization with PCI or coronary artery bypass
surgery may be considered.
• In patients with severe left ventricular dysfunction

(EF<35%, NYHA functional class II or III) and the
possibility of life-threatening dysrhythmias, placement
of an ICD can prevent sudden cardiac death and extend
survival.
131
Nursing intervention
oMonitor intake & output , weighing the patient
daily
oDetermining the degree of JVD
oMonitoring pulse rate & BP
oExamine skin turgor & mucus membranes for
signs of dehydration
oAssessing symptoms of fluid overload
oMonitoring & managing potential complication
oPromoting activity tolerance
oControlling anxiety, minimizing powerlessness
132
Thanks !
133
Hematological disorders
134
Anemia
Definition:
 Anemia has been defined as a reduction in one or more of the major red blood
cell (RBC) measurements:
• Hemoglobin concentration,
• Hematocrit, or
• RBC count:
 Physiologic function : a reduction in RBC mass and a cross ponding decrease in
the oxygen carrying capacity
 Laboratory : a reduction of hgb or HCT below the normal.
135
Cont`d
 WHO criteria: anemia should be exist in adults
when hgb <13g/dl in male and <12g/dl in female.
Pathophysiologic classification
1.Impaired RBC production
 Aplastic anemia
 IDA
 Megaloblastic anemia
 Anemia of chronic illness
2.RBC destruction
A. Bleeding
B. Hereditary hemolytic disease
C. Acquired hemolytic disease(autoimmune, drugs)
136
Cont`d
o Fatigue, weakness & restlessness (early)
o Pallor, dyspnea on exertion, tachycardia, cardiomegaly,
o Irritability, dizziness, lethargy
Due to bleeding
◦ Easy fatigability, muscle cramps, postural dizziness
◦ Lethargy, syncope- fainting, hypotension/shock/death
Diagnosis
Hemoglobin, hematocrit, RBC count,
137
Cont`d
Complications
Heart failure
Paresthesia & confusion
Medical management
Directly toward treating of underline causes
Transfusion of packed RBCS (severe).
Nursing management
Managing fatigue
Maintaining adequate nutrition
Maintaining adequate perfusion
Promoting compliance with prescribed therapy
Monitoring & managing potential complications.
138
Iron deficiency anemia(IDA)
oResults when the intake of dietary iron is inadequate
for hemoglobin synthesis.
oCommon in all age & underdeveloped countries
Clinical manifestations:-
 Typical of IDA
◦ Koilonychia (spoon nails)
◦ Blue sclera
◦ Dysphagia
 Generally lower iron values for women because of menstrual loss, pregnancy,
lactation
139
Iron deficiency anemia(IDA
Diagnosis
History ,bone marrow aspiration. Hematocrit, RBC & S/e(hookworm)
Medical management
Ferrous sulphate, ferrous gluconate, &
Ferrous fumerate, iron dextran IM/IV, blood transfusion
Nursing management
Health education on preventive method
Food sources high in iron include organ meats, other meats, beans, leafy green
vegetables.
Taking iron-rich foods with a source of vitamin c enhances the absorption of iron
Advise the patient to take iron in an empty stomach.
140
Megaloblastic anemia
• Vitamin B12 & folate deficiency results

defective DNA synthesis
• Vitamin B12 deficiency
◦ Take longer time to develop
◦ Neurological manifestations may come early
• Folate deficiency
• Can develop in relatively short duration
• Pregnancy, acute & severe infection, severe
hemolysis
141
Aplastic anemia
Causes
Decrease in or damage to marrow stem cells,
damage to the microenvironment with in the
marrow, &
Replacement of the marrow with fat.
It results in bone marrow aplasia
o Often insidious
o Infection & symptoms of anemia
o Purpura (bruising) may develop later
142
Aplastic anemia
Diagnosis
o Hx of ingesting medication or chemicals in high doses
o Bone marrow aspiration
Medical management
Bone marrow transplantation or peripheral blood stem cell transplantation
Immunosuppressive therapy.
Combination of antithymocyte globulin & cyclosporine
Supportive therapy- transfusions of rbcs & platelets
Nursing management
• Assess the pt for signs of infection & bleeding
143
Hemophilia
Definition: hemophilia is an inherited bleeding disorder

that slows the blood clotting process.
Two types of inherited bleeding disorders
1. Hemophilia A: caused by a genetic defect that
results in deficient or defective factor VIII
2. Hemophilia B; hemophilia B (christmas disease)
stems from a genetic defect that causes deficient or
defective factor IX;
Both types of hemophilia are inherited as x-linked traits, so almost all affected
people are males;
 Females can be carriers but are almost always asymptomatic.
144
Hemophilia
 Hemorrhages in to various parts of the body
 Hemorrhage can occur even after minimal trauma
 The frequency & severity of the bleeding depends
• Degree of factor deficiency
• Intensity of the precipitating trauma
 Joint bleeding (75%)
 Pain in a joint & ankylosis (fixation)
 Bleeding with out trauma & progressively extend
in all directions(sever)
 Decreased sensation, weakness, & atrophy of the
body
 Spontaneous hematuria & GI bleeding
 Nasal passage bleeding
145
Hemophilia
Hemorrhage is in the head (intracranial or extra

cranial) is dangerous
Surgical procedures exacerbate
Poor wound healing
Management
Factor VIII & factor IX concentrates can be
administered
Transfusion of fresh or frozen plasma
Nursing management
Assist the patient to cope
Encourage to be self-sufficient & to maintain
independence by preventing unnecessary trauma.
Health education about activity restriction &
self-care measures.
146
Hemophilia
Avoidance of use of aspirin , nsaids, herbs, nutritional supplements & alcohols

Dental hygiene
Splint may be useful in patients with joint or muscular hemorrhage
Invasive procedures should be minimized or performed after administration of
appropriate factor replacement
During hemorrhage episodes, the extent of bleeding must be assessed carefully
Analgesics are administered to alleviate the pain
147
Thrombocytopenia (low platelet level)
Causes
Decreased production of platelets within the bone marrow,
Increased destruction of platelets, or
Bleeding & petechiae
Platelet > 50,000/mm3, excessive bleeding can
follow surgery or other trauma;
Platelet <20,000/mm3, petechiae can appear,
along with nose , gingival & excessive bleeding
after surgery or dental extractions.
Platelet <5000/mm3, spontaneous, potentially
fatal cns or git hemorrhage.
148
Cont`d
Diagnosis
Bone marrow aspiration
Cbc
Management
Treatment of underline causes (secondary)
Platelet transfusions
Nursing intervention
oAvoid ASA
oUse stool softeners, oral laxatives
oControl bleeding
oAdminister platelets, fresh frozen plasma,
packed red blood cells
149
Polycythemia
Definition: polycythemia refers to an increased
volume of RBCS.
Hct>55% in males & >50% in females.
Classification
1. Polycythemia vera or primary polycythemia: is a
proliferative disorder in which the myeloid stem
cells seem to have escaped normal control
mechanisms.
o Hyper cellular, rbc, wbc, and platelet counts in the peripheral blood are
elevated.
o Hct> 60%.
150
Cont`d
Causes:
Myeloid stem cells are un able to control normal mechanisms.
Hyper cellular of bone marrow
2. Secondary polycythemia: is caused by excessive
production of erythropoietin.
 This may occur in response to:
o Erythropoietin- producing neoplasms
o Chronic hypoxemia (e.G. Copd)
o Smoking
151
Cont`d
Splenomegally
Head ache, dizziness, tinnitus, fatigue, & blurred vision or
Increased blood viscosity (angina, claudication, dyspnea, & thrombophlebitis),
Generalized pruritus
Erythromelalgia: a burning sensation in the fingers & toes.
Diagnosis
Rbc(elevated)
Splenomegaly
Wbc & platelet (elevated)
152
Cont`d
Complications
o Bleeding is also a complication.
o Increased risk for thrombosis
o Cva or heart attack
Medical management
Allopurinol- high uric acid concentration
Radioactive phosphorus (32P) or chemotherapeutic agents (hydroxyurea)- to
suppress marrow function
Low dose of ASA
Anagleride (agrylin) inhibits platelet aggregation & control the
thrombocytosis
153
Cont`d
Nursing management
o Risk factors for thrombotic complications should be assessed, & patients should
be instructed regarding the S/S of thrombosis.
o Patients with bleeding usually advised to avoid asa.
o Minimizing alcohol intake
o For pruritus, the nurse may recommend bathing in tepid or cool water.
154
Leukemia
Definition: leukemia is a cancer of the blood or bone marrow and

is characterized by an abnormal proliferation of blood cells,
usually WBC (leukocytes).
Leukemia's are neoplasm of erythropoietin cells of bone marrow
that later disseminates to other organs like lymph node, spleen &
liver.
Classification
Depends on: cell of origin & clinical course
Acute lymphoblastic leukemia (ALL)
Chronic lymphoblastic leukemia (CLL)
Acute myeloblastic leukemia (AML)
Chronic myeloblastic leukemia (CML) 155
Etiology:
Cont`d
Unknown
Genetic predisposition
Environmental factors:
oIonizing radiation:
oChemicals:
oInfections e.G. Virus
Acute leukemia:
oCharacterized by presence of immature WBC in the
marrow and peripheral blood.
Acute lymphoblastic leukemia(all)
Common in pediatrics
Lymphoblast are characteristics features in the
circulation and bone marrow[bm].
156
Cont`d
Acute myeloblastic leukemia (AML)
Presence of myeloblasts in peripheral or bone
marrow
Larger than lymphoblast
Clinical features
Both AML & ALL have overlapping features
The symptoms are usually less than 3 months
Symptoms of anemia
Recurrent infection
Bleeding tendency: pallor,
Palpable lymph node, spleen & liver
Meningitis
157
Cont`d
Diagnosis
CBC
Peripheral blood film: leukemic cells
Bone marrow aspiration.
Treatments
Treatment of specific diagnosis
e.G. Anemia, infection
Chemotherapy:
158
Cont`d
Chronic leukemia
A. Chronic lymphoblastic leukemia (CLL)
oIts uncontrolled proliferation and accumulation of
mature lymphocytes.
Clinical features
25% the diagnosis is made incidentally
Sign & symptoms of marrow failure
Recurrent infection, anemia
LN, spleen and liver enlargement
Diagnosis
CBC
Bone marrow
Decreased immunoglobulin
159
Lymphatic system
• Lymphatic system consists of a network of collecting ducts, lymph

fluids e.G. Spleen, thymus, tonsils, adenoids--- etc
• Major lymph node groups located symmetrically either side of head &
neck.
• Each group drains specific region
Function
• Movement and transportation of lymphocytes
• Production of lymphocytes.
• Production of antibodies.
• Phagocytosis
• Absorption of fat and fat soluble substances.
160
Lymphadenitis
• Infections can either originate from the organs that they
drain or primarily within the lymph node itself, referred
to as lymphadenitis.
• Infected lymph nodes tend to be: firm, tender, enlarged

and warm.
• Inflammation can spread to the overlying skin, causing it
to appear reddened
• The center of the node may become necrotic, resulting in

the accumulation of fluid and debris within the structure.
Becomes abscess
161
Hodgkin lymphoma
• Hodgkin lymphoma is an uncommon cancer that develops in the
lymphatic system, which is a network of vessels and glands spread
throughout your body.
• The lymphatic system is part of your immune system.
• Clear fluid called lymph flows through the lymphatic vessels and contains
infection-fighting white blood cells, known as lymphocytes.
• In hodgkin lymphoma, b-lymphocytes (a particular type of lymphocyte)
start to multiply in an abnormal way and begin to collect in certain parts
of the lymphatic system, such as the lymph nodes
162
Lymphadenophaty
• Is the medical term for enlargement in one or more lymph nodes, usually
due to infection.
• Lymph nodes are filled with white blood cells that help your body fight
infections.
• When lymph nodes become infected, it's usually because an infection
started somewhere else in your body. Rarely, lymph nodes can enlarge due
to cancer.
Lymphangitis:
The lymphatic system also filters a whitish-clear fluid called lymph,
which contains bacteria-killing white blood cells.
163
Thanks !
164

Cardiovascular Disorders

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Cardiovascular Disorders

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CARDIOVASCULAR

• The heart is composed of three layers

Pulse volume (amplitude)

N.B: If the PMI is below the 5th ICS or lateral to the

ECG (electro cardiograph)

On completion of this session the learner will be able to:

• Systemic arterial BP is the pressure exerted on the walls of the

 A normal BP in adults is considered a systolic BP less than 120

• HPN is a amount of resistance of blood pumping through

• It is when systolic B/P  140 mm Hg and a diastolic pressure  90

• Classification of Blood Pressure for Adults Age 18 and Olders

• People with hypertension can be asymptomatic and remain so for

• However, when specific signs and symptoms appear, they usually

Coronary artery disease with angina or myocardial infarction is a

• When heart damage is extensive, heart failure ensues.

• Pathologic changes in the kidneys (indicated by increased [BUN] and

• Cerebral infarctions account for most of the strokes and TIAs in

Health history and physical examination

The goal of hypertension treatment is to prevent death and

The optimal management plan is inexpensive, simple, and causes the

• For patients with uncomplicated hypertension and no specific indications

• Patients are first given low doses of medication.

Reducing sympathetic outflow

 Calcium antagonists reduce vascular resistance through L-channel blockade,

• Lose weight if overweight

• Limit alcohol intake

• Increase aerobic physical activity

• Reduce sodium intake to no more than 100 mmol per day

• Maintain adequate intake of dietary potassium

• Maintain adequate intake of dietary calcium and magnesium for general

 Two major forms:

Is characterized sever elevation of SBP, > 180 ,

Cardio vascular ischemia

• Optimal therapy varies with the type of hypertensive emergency.

• Hydralazine, 5-10 mg initial dose, repeated every 20 to 30 minutes

There is asymptomatic sever hypertension with

•For previously treated patients-adjust existing medication

Provide written information : expected effects and side effects of

• Extremely close hemodynamic monitoring of the patient’s blood

• ↓ BP is called Hypotension (Below 90/60 mm of Hg)

Rapid and shallow Respirations, Crackles

Major goals in treating hypotension are :

I. Restore intravascular volume to reverse the sequence of events

II. Redistribute fluid volume.

III. Correct the underlying cause of the fluid loss as quickly as

A. Treatment of the underlying cause

B. Fluid replacement to restore intravascular

C. Vasoactive medications to restore vasomotor tone

D. Nutritional support to address the metabolic

This may involve applying pressure to the bleeding site or surgery to

If the cause of the hypovolemia is diarrhea or vomiting, treat diarrhea

• The fluids administered may include

 crystalloids (0.9% N/S,RL),

Nutritional support is an important aspect of care for the patient with

Is a blood clot (thrombus) that forms within a vein

Risk factors for thromboplebitis

• Phlebothrombosis: thrombus without inflammation.

• Thrombosis: formation or presence of a thrombus, e.g. thrombosis of

History and physical examination

Doppler ultrasound of leg and pelvic veins

Blood laboratory studies

Homans' sign has been used historically to assess for DVT.

• Chronic venous insufficiency and