NURS 6501 Concepts of Cardiovascular and Respiratory Disorders
NURS 6501 Concepts of Cardiovascular and Respiratory Disorders
NURS 6501 Concepts of Cardiovascular and Respiratory Disorders
The circulatory system and the respiratory system are powerful partners in health. While they work closely together in good health, a disease or disorder that manifests in one can have a significant impact on both, hampering the pair’s ability to collaborate.
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Cardiovascular and respiratory disease and disorders are among the most common reasons for hospital visits, and among the leading causes of fatality. Heart disease and pneumonias are among the most familiar, but a wide variety of issues can impact physiological functioning of one or both systems.
This week, you examine fundamental concepts of cardiovascular and respiratory disorders. You explore common diseases and disorders that impact these systems, and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.
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Scenario 1: Myocardial Infarction
CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.”
HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.
Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
Question:
1. How does inflammation contribute to the development of atherosclerosis?
Chronic inflammatory processes in the heart muscle can lead to inflammation-induced mitochondrial damage. This damage, in turn, triggers an increase in the production of free radicals, which further perpetuates the cycle of chronic inflammation.
Scenario 2: Pleural Friction Rub
A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
1. Because of the result of a pleural friction rub, what does the APRN recognize?
The APRN recognizes that the presence of a pleural friction rub in this case indicates the involvement of the pleura, which is the lining surrounding the lungs. A pleural friction rub is a specific auscultatory finding characterized by a dry, grating, or rubbing sound heard during inspiration and expiration. It occurs when the inflamed surfaces of the pleura rub against each other during respiratory movements. In the given scenario, the presence of a pleural friction rub suggests that the inflammation extends beyond the pericardium, potentially involving the adjacent pleura. This finding, along with the patient’s symptoms of retrosternal chest pain that worsens with breathing and her history of systemic lupus erythematosus (SLE), raises suspicion for acute pericarditis. The APRN recognizes the importance of further evaluation and appropriate management for this patient, considering the potential complications and underlying autoimmune condition.
Scenario 4: Deep Venous Thrombosis (DVT)
A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).
Question:
1. Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)
The occurrence of Virchow’s Triad leads to damage in the vessel walls. When the intimal layer of the vessel is injured, substances like nitric oxide and prostacyclin, which have antiplatelet properties, are affected. This, combined with the expression of collagen on the vessel wall, promotes the adherence of platelets to the vessel wall. Subsequently, the activated platelets aggregate, leading to the formation of clots. In this particular case, factors such as venous stasis due to obesity, the patient’s advanced age, and their inability to engage in physical therapy contribute to the venous stasis, further exacerbating the risk of clot formation.
Scenario 5: COPD
A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema. He asks if this means he has chronic obstructive pulmonary disease (COPD).
Question:
1. There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.
Emphysema is a condition affecting the airways, characterized by the permanent enlargement of the air exchange pathways. It is associated with the destruction of alveolar walls, which do not exhibit fibrosis. Chronic exposure to irritants triggers the recruitment of neutrophils, macrophages, and lymphocytes to the lungs, leading to progressive damage caused by inflammatory oxidative stress. In emphysema, the destruction of alveoli results in a reduced surface area available for efficient gas exchange. Consequently, this leads to a significant mismatch between ventilation and perfusion, impacting the overall respiratory function.
Learning Objectives
Students will:
- Analyze concepts and principles of pathophysiology across the lifespan
Learning Resources
Required Readings (click to expand/reduce)
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
- Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
- Chapter 35: Structure and Function of the Pulmonary System; Summary Review
- Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery hypertension); Summary Review
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Required Media (click to expand/reduce)
Module 2 Overview with Dr. Tara Harris
Dr. Tara Harris reviews the structure of Module 2 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and Assignment. (4m)
Cardiovascular Respiratory Disorders – Week 3 (16m)
Pneumonia
Note: The approximate length of the media program is 13 minutes.
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 32, 33, 35, and 36 that relate to cardiorespiratory systems and alteration in cardiorespiratory systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/
Knowledge Check: Cardiovascular and Respiratory Disorders
In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
-
- myocardial infarction
- endocarditis
- myocarditis
- valvular disorders
- lipid panels
- coagulation
- clotting cascade
- deep vein thrombosis
- hypertension
- heart failure
- COPD
- asthma
- pneumonias
Photo Credit: Getty Images/Science Photo Library RF
Complete the Knowledge Check by Day 7 of Week 3
To complete this Knowledge Check:
Module 2 Knowledge Check
What’s Coming Up in Week 4?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will examine the alterations in the cardiovascular and respiratory systems and the resultant disease processes through case study analysis. You will also consider patient characteristics, including racial and ethnic variables, which may impact altered physiology.
Next Week
Question 13
1 out of 1 points
A 64-year-old woman with moderately severe COPD comes to the pulmonary clinic for her quarterly checkup. The APRN reviewing the chart notes that the patient has lost 5% of her body weight since her last visit. The APRN questions the patient and patient admits to not having much of an appetite and she also admits to missing some meals because it “takes too much work” to cook and consume dinner.
Question:The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition. |
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An elderly 81-year-old obese lady developed deep venous thrombosis confirmed by a duplex ultrasound 48 hours after a left total hip replacement operation. She presented with severe nausea and vomiting that resulted in dry mucous membranes. She presented with typical features of deep venous thrombosis such as leg swelling, calf tenderness, and redness on the operated leg (Mazzolai et al., 2018). The development of deep venous thrombosis is a common complication following total hip replacement surgery (Yu et al., 2021). The consequences include prolonged hospital stay, adverse patient outcomes, predisposition to pulmonary embolism, and high economic implications.
Various mechanisms lead to the development of deep venous thrombosis. These include factors that lead to venous stasis, endothelial injury, and hypercoagulability described as Virchow’s triad (McLendon et al., 2022). Identified risk factors include immobilization, surgery, and trauma (Othieno et al., 2018). Obesity, advanced age, dehydration, thrombocytosis, and a previous history also predispose to deep venous thrombosis (Waheed et al., 2022). The patient in this scenario was elderly, obese, and had just undergone surgery.
Surgery activates inflammatory response with the release of cytokines which activates the coagulation system (Yu et al., 2021). The surgery also contributed to immobility due to the resultant bed rest and immobility under anesthesia during the long operation. There is a history of severe nausea and vomiting. This may have led to dehydration evidenced by dry mucous membranes with resultant hypercoagulability. There is no mention of postoperative prophylactic anticoagulant therapy which would have minimized the development of deep venous thrombosis.
References
Mazzolai, L., Aboyans, V., Ageno, W., Agnelli, G., Alatri, A., Bauersachs, R., Brekelmans, M. P., Büller, H. R., Elias, A., Farge, D., Konstantinides, S., Palareti, G., Prandoni, P., Righini, M., Torbicki, A., Vlachopoulos, C., & Brodmann, M. (2018). Diagnosis and management of acute deep vein thrombosis: A joint consensus document from the European Society of cardiology working groups of the aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. European Heart Journal, 39(47), 4208–4218. https://doi.org/10.1093/eurheartj/ehx003
McLendon, K., Goyal, A., & Attia, M. (2022). Deep Venous Thrombosis Risk Factors. In StatPearls. StatPearls Publishing.
Othieno, R., Okpo, E., & Forster, R. (2018). Home versus in-patient treatment for deep vein thrombosis. Cochrane Database of Systematic Reviews, 2018(1). https://doi.org/10.1002/14651858.cd003076.pub3
Waheed, S. M., Kudaravalli, P., & Hotwagner, D. T. (2022). Deep Vein Thrombosis. In StatPearls. StatPearls Publishing.
Yu, X., Wu, Y. & Ning, R. The deep vein thrombosis of the lower limb after total hip arthroplasty: what should we care. BMC Musculoskelet Disord 22, 547 (2021). https://doi.org/10.1186/s12891-021-04417-z