cura mono,rheu,hyper

8/4/2019 CURA Mono,Rheu,Hyper

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Mononucleosis


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What is mononucleosis

Infectious mononucleosis

sometimes called "mono" or

"the kissing disease," is an

infection usually caused by the

Epstein-Barr virus (EBV).

EBV is very common, and

many people have been exposed

to the virus at some time inchildhood.
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EBV infectious mononucleosis (also knownas Pfeiffer's disease, colloquially as thekissing disease, or as mono in NorthernAmericaand more commonly known asglandular feverin other English-speakingcountries) is an infectious, viral disease

which most commonly occurs in adolescents

and young adults often in 15- to 17-year-olds,the infection may occur at any age
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How it is transmitted? often transmitted by saliva by kissing someone

who has been infected

direct contact with saliva (spit) from someoneinfected with EBV, such as by sharing a straw, atoothbrush, or an eating utensil.

occurring most often in 15- to 17-year-olds, theinfection may occur at any age.


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Symptoms usually begin to appear 4 to 7 weeksafter infection with the virus

constant fatiguefever

loss of appetite

sore muscles /stiffness

skin rash

abdominal pain


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swollen lymph nodes (commonly calledglands, located in your neck, underarms,and groin )
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Less frequently occurring symptoms include: Jaundice (yellow cast to skin)

Headache

Neck stiffness

Sensitivity to light Cough

Shortness of breath

Chest pain

Rapid heart rate

Fatigue

Nosebleed

Hives

symptoms of mono

gradually go away ontheir own over a periodof weeks to months.
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PathophysiologyEBV

oral secretions ( saliva) up to8 weeks incubation period

replication of virus

within epithelialcells in the pharynx

SORE THROAT

within B cells ( invadedvia their CD21)

immune response

IgM Ab

cytotoxic (CD 8 +) T cells

infected by B lymphocytes

ATYPICAL LYMPHOCYTES( Downey Cells)Heterphite Ab production
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The most commonly used diagnostic criteria is thepresence of 50% lymphocytes with at least 10% atypicallymphocytes (large, irregular nucleiwhilst the person

also has fever, pharyngitis and adenopathy. Physical exam - swollen lymph nodes, tonsils,

liver or spleen Blood tests - confirms mononucleosis

Antibody tests (monospot test )Epstein-Barr virus antigenby

immunofluorescence (positive for EBV)

Epstein-Barr virus antibody titers to help distinguishacute infection from past infection with

EBVWhite blood cell count - elevated number of white

blood cells (lymphocytes) or abnormal-looking lymphocytes.(unusual-appearingwhite blood

cells )
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Susceptibility

If antibodies to the viral capsid antigen are

not detected (IgM & IgG), the patient is susceptible toEBV infection

Primary Infection

is indicated if IgM antibody to the viral capsid

antigen is present and antibody to EBV nuclear antigen,or EBNA, is absent

rising or high IgG antibody to the viral capsidantigen and negative antibody to EBNA after at least 4weeks of illness is also strongly suggestive of primaryinfection


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Past Infection

antibodies to both the viral capsid antigen andEBNA are present (from 4 to 6 months to yearsearlier)

Reactivation

presence of antibodies to EBNA

an elevation of antibodies to early antigengen

Chronic EBV Infection

illness lasts more than 6 months, investigateother causes of chronic illness


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acute cytomegalovirus and Toxoplasma gondiiinfections

Acute HIV infection

Leukemia Diphtheria

common cold

influenza (the flu)
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is generally self-limiting and only symptomaticand/or supportive treatments are used

Most patients recover within 2-4 weekswithout medication

Rest is recommended during the acute phase ofthe infection, but activity should be resumed onceacute symptoms have resolved

heavy physical activity and contact sports should

be avoided to abrogate the risk of splenic rupture,for at least one month following initial infectionand until splenomegaly has resolved, asdetermined by ultrasound scan
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Treatment acetaminophen/paracetamol or non-steroidal anti-

inflammatory drugs(NSAIDs) to reduce fever andpain

Intravenous corticosteroids, usually hydrocortisone

or dexamethasone, are not recommended for routineuse[15] but may be useful if there is a risk of airwayobstruction, severe thrombocytopenia, orhemolytic anemia

aciclovir, may reduce initial viral shedding antiviral drug valacyclovir has recently been shown

to lower or eliminate the presence of the Epstein-Barr virus in subjects afflicted with acute

mononucleosis, leading to a significant decrease inthe severity of symptoms.
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Antibioticsare not used as they are ineffectiveagainst viral infections.

amoxicillinand ampicillin are relativelycontraindicated in the case of any coincidingbacterial infections during mononucleosis

because their use can frequently precipitate a non-allergic rash.

In a small percentage of cases, mononucleosisinfection is complicated by co-infection withstreptococcal infection in the throat and tonsils (strep

throat). Penicillinor other antibiotics (with theexception of the two mentioned above) should beadministered to treat the strep throat.

Opioid analgesics are also relativelycontraindicated due to risk of respiratorydepression.
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Complications Enlargement of the spleen

significant complications of mononucleosis

In extreme cases, spleen may rupture, causingsharp, sudden pain in the left side of your upper

abdomen. If such pain occurs, seek medical attentionimmediately you may need surgery.

Hepatitis

Jaundice


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Prevention Mononucleosis is spread through saliva. If you're

infected, you can help prevent spreading the virusto others by not kissing them and by not sharingfood, dishes, glasses and utensils until several

days after your fever has subsided and evenlonger, if possible.

The Epstein-Barr virus may persist in your salivafor months after the infection. There's no vaccine

to prevent mononucleosis.


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Fatigue R/T the infectious process

Hyperthermia R/T the infectious process

Acute pain R/T throat inflammation &

swelling


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Administer medications to treat symptoms ,as needed

Provide warm saline gargles for symptomaticrelief of sorethroat

Provide adequate fluids and nutrition

Plan care to provide frequent rest periods

Check the patients temperature regularly

Monitor patients response to analgesics,antipyretics, & other supportive measures


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Explain that convalescence may take severalweeks, usually until the patients WBC count

returns to normal

Stress the need for bed rest during acute illness

Warn patient to avoid excessive activity, whichcould lead to splenic rupture

To minimize throat discomfort, encourage patient

to drink milk shakes, fruit juices, and broths andto eat cool, bland foods


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Rheumatic Heart Disease


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I know youll like this!!!


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And this!!!


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Definitely, who wouldnt want this?!


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Will you still want this?!


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Stick around for this.


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Streptococcal (strep) infections are

communicable diseases that develop

when Streptococcus bacteria normallyfound on the skin or in the intestines,

mouth, nose, reproductive tract, orurinary tract invade other parts of the

body and contaminate blood or tissue.


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Rheumatic Fever

Rf is a diffuse, inflammatory disease causedby a delayed exaggerated immune response toinfection by the group A B-hemolyticstreptococcus in genetically predisposed

individuals.- Is a febrile illness- If untreated, can cause scarring and deformity

of cardiac structures - RHD

Streptococci are a part of normal animalflora!

It is believed to be caused by antibody cross-reactivity and can involve the heart, joints, skin,and brain


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Epidemiology

2 3 % of people with untreated Group Abeta-hemolytic streptococcal infection.

470,000 new cases and 233,000 deathseach year.

Mostly in developing countries, amongindigenous groups.

over 15 million people are estimated to have

rheumatic heart disease. In the US and other developed countries the

incidence is low (hygiene and routine

antibiotic use)


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Predisposing Factors

AGE90% occur between the ages of 5 15 y.o.

- Also the AGED, severe cardiac disability anddeath.

SOCIOECONOMIC FACTORSslum, citydweller more than the farmer.

GENETICSmay appear to develop inhousehold members.


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Etiology

Exact cause remains uncertain!- bacteria do not grow within the heart and joints

2 Theories: The body undergoes an allergic response to invading

streptococci.

The host develop an autoimmune response in whichstreptococcal antibodies attack the host tissue. Basis of the theories:

1. RF develops following an URTI by streptococci2. The devlp of RF is between 1 - 5weeks, with an averageof 18 days. The time our body needs to sensitized anorganism and undergo immune response.3. Since only 2 -3 % devlp RF after strep. throat, it has beenhypothesized that these people have a greaterimmunological reaction.


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Pathophysiology

Predisposing Factors

Invasion of streptococcus from normal flora

Pharyngitis

Treatment initiated If untreated

macrophages presents bacterial antigen to

lymphocyteActivation ofT-cells

Activation ofB-cells

T- Suppressor

T-Killer

T- Helper

Antibody Prodxn.

Failure ofSuppressor

cell

*Cross reactn with cardiac myofibermyosin, and smooth muscle of

arteries


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*Cytokine release

*Inflammatory process away from primary site of Strep.Infxn.

*Joint CNS HEARTSmooth muscle of

arteries

*Chorea Skin

Polyarthritis *Erythema marginatum


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Endocardial inflammation

Swelling of the valve leaflets

Erosion along the leaflets

*Deposition of platelets and fibrin on eroded valvulartissue BD

Become progressively adherent scarring and

shortening of

leaflets

Valves becomes narrowed Regurgitation of

blood


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Increase cardiac workload

HEART FAILURE

B


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B

Myocardium

*Aschoff bodies

C

Valve loose its elasticity

Mitral, aortic, tricuspid valve dysfunction

murmur


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D

Pericardial Inflammation

Chest pain serofibrinouseffusion

Audible frictionrub


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Assessment Almost always follows a streptococcal infection of the

nasopharynx.

Did you experience sore throat lately? How often?Signs and Symptoms:

1. Polyarthritis prominent finding; last hours to days

2. Carditis common manifestation

3. Relapsing fever 38o C and episode of normal temp.4. Subcutaneous nodules small, painless firm nodules

(knees, knuckles, and elbows); usually in children; onlyin first week.

5. Erythema Marginatumcrescent shape lesion withclear centers chicken-wire rash

6. Abdominal painmay be related to liver engorgement

7. Sydenhams chorea St. Vitus dance; late stages,usually in girls; Involuntary grimacing and jerky,purposeless movements.

8. Malaise, weakness, weight loss, and anorexiaAs


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B

Erythema Marginatum

Subcutaneous nodules


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Diagnostic Measures

There is no single diagnostic feature identifies

rheumatic fever.

JONES CRITERIA

- gauges the probability of the presence of rheumatic

fever in an individual.Premise:

1. Diagnosis requires two major manifestation

2. One major manifestation and two minor

manifestation


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Medical Intervention

Control and alleviate infecting streptococci if stillpresent.

Protect the heart against the damaging effects ofcarditis.

Relieve joint pain, fever, and other symptoms. Typical intervention:

1. Chemotherapy with penicillin, salicylates, and

steriods

2. Bed rest

3. Proper diet


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Diagnosis Rheumatic fever is mainly a clinical diagnosis

No single diagnostic sign or specific laboratorytest available for diagnosis

physical exam may include:

1. Checking the joints for pain and inflammation

2. Examining the skin for rashes or lumps

3. Listening to the heart for abnormal rhythms ormurmurs

4. Doing a neurological exam to check for abnormalmovements

To diagnose rheumatic fever, doctors generally look for


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g , g yevidence of a preceding strep throat infection, which ischaracterized by:

Sore throat

Red and swollen tonsils

Fever

Fatigue

Abdominal pain (in younger children)

Tender lymph nodes in the front of the neck

Headache Muscle aches

11/27/08

Norimel Andrea A. Labarda,RN,MAN

45


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Diagnosis based on

MODIFIED JONESCRITERIA

11/27/08Norimel Andrea A.Labarda,RN,MAN

46


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Jones Criteria (Revised) for Guidance in theDiagnosis of Rheumatic Fever*

Major Manifestation Minor

Manifestations

Supporting Evidence

of Streptococal InfectionCarditis

PolyarthritisChorea

Erythema MarginatumSubcutaneous Nodules

Clinical Laboratory

Increased Titer of Anti-Streptococcal Antibodies ASO

(anti-streptolysin O),

othersPositive Throat Culturefor Group A Streptococcus

Recent Scarlet Fever

Previousrheumaticfever orrheumaticheart diseaseArthralgiaFever

Acute phasereactants:Erythrocytesedimentationrate,C-reactive

protein,

leukocytosisProlonged P-

R interval

*The presence of two major criteria, or of one major and two minor criteria,indicates a high probability of acute rheumatic fever, if supported by evidence of

Group A streptococcal nfection.


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Exceptions to Jones Criteria

Chorea alone, if other causes have beenexcluded

Insidious or late-onset carditis with no

other explanationPatients with documented RHD or prior

rheumatic fever,one major criterion,or of

fever,arthralgia or high CRP suggestsrecurrence


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11/27/08Norimel Andrea A. Labarda, RN,MAN

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Are to relieve symptoms,

destroy the group Astreptococcus and prevent futureinfection.

Goals of Treatment


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Treatment Step I - primary prevention

(eradication of streptococci)

Step II - anti inflammatory treatment(aspirin,steroids)

Step III- supportive management &management of complications

Step IV- secondary prevention(prevention of recurrent attacks)

(T


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STEP I: Primary Prevention of Rheumatic Fever (Treatmentof Streptococcal Tonsillopharyngitis)

Agent Dose Mode Duration

Benzathine penicillin G 600 000 U for patients Intramuscular Once27 kg (60 lb)1 200 000 U for patients >27 kg

or

Penicillin V Children: 250 mg 2-3 times daily Oral 10 d

(phenoxymethyl penicillin) Adolescents and adults:500 mg 2-3 times daily

For individuals allergic to penicillin

Erythromycin: 20-40 mg/kg/d 2-4 times daily Oral 10 dEstolate (maximum 1 g/d)

or

Ethylsuccinate 40 mg/kg/d 2-4 times daily Oral 10 d(maximum 1 g/d)

Recommendations of American Heart Association


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Step II: Anti inflammatory treatmentClinical condition Drugs

Arthritis only Aspirin 75-100 mg/kg/day give as 4

divided doses for 6 weeks (Attain a blood

level of 20-30mg/dl)

Carditis Prednisolone 2-2.5 mg/kg/day Give as 2divided doses for 2 weeks

Taper over 2 weeks while tapering give

aspirin 75mg/kg/day for 2 weeksContinue aspirin alone 100mg/kg/day for

another 4 weeks


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Bed rest

Treatment of congestive cardiac failure: -

digitalis,diuretics

Treatment of chorea:-diazepam or haloperidol

Rest to joints & supportive splinting

3.Step III: Supportive management &

management of complications

STEP IV S d P ti f Rh ti F


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STEP IV : Secondary Prevention of Rheumatic Fever(Prevention of Recurrent Attacks)

Agent Dose Mode

Benzathine penicillin G 1 200 000 U every 4 weeks* Intramuscular

or

Penicillin V 250 mg twice daily Oral

or

Sulfadiazine 0.5 g once daily for patients 27 kg (60 lb Oral1.0 g once daily for patients >27 kg (60 lb)

For individuals allergic to penicillin and sulfadiazine

Erythromycin 250 mg twice daily Oral

*In high-risk situations, administration every 3 weeks is justified andrecommended

Recommendations of American Heart Association


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Pharmacologic Intervention

PENICILLIN for 10 days ff. the onset of rheumatic fever.

ERYTHROMYCIN if allergic to penicillin

Prophylactic dosesof same med is given to prevent furtherattacks

Monthly injections of Longacting Penicillin must be given for aperiod of 5 years in patients having one attack of Rheumatic fever

SALICYLATES to control fever and to relieve joint pain.

Aspiringive with food to reduce gastric irritation

STERIODS relieve inflammatory symptoms; prevent further scarringof tissue and may prevent development of sequelae such as Mitralstenosis

CARDIAC GLYCOSIDES(digitalis) and DIURETICS

Nursing Management


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g g NURSING ASSESSMENT

* Cardiac function

* Tolerance to activity and feelings towards restriction

* Support Systems

* Coping Strategies

* Nutritional Status

* Level of Discomfort

* Knowledge with RFNURSING GOALS

1. Person will demonstrate progression toward an optimal level of

physical activity tolerance.

2. Person will use adaptive coping strategies.

3. Person will experience increased comfort.

4. Person will show fewer behavioral and physical symptoms ofanxiety.

5. Person will maintain or restore proper nutritional balance.

6. The person will restore or maintain hemodynamic status lungs,

Urine output, weight,

Nursing Dx and Interaction


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Nursing Dx and Interaction

Alteration in Comfort Activity IntoleranceBed rest(reduces strain on the heart and

reduces metabolic needs)* Temp is normal without salicylates* Resting pulse (adults) < 100* ECG shows no signs of myocardial damage* ESR rate returns to normal

Alteration in Nutrition: Less than Body Requirements

Knowledge Deficit Regarding Preventive Measures AgainstInitial and Recurring Attacks of Rheumatic Fever* Continue prophylactic medication for five years.* Prophylactic medication before and after surgery or dental

procedure. (for bacterial endocarditis)* Advise patient that they have to adhere this permanently.

* Proper dental hygiene and prompt dental care.* Avoid people who had recent streptococcal infection.* It is very important to begin antibiotic therapy after

pharyngitishas developed.


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Prognosis and Complication

With antibiotic therapy, the prognosis is generallygood. (only 1 2 % die from initial attack; acutemyocarditis)

Laboratory and clinical signs subsides within one to

two months following therapy.

Some develop residual heart damage:

MITRAL REGURGITATION and/or STENOSIS

AORTIC REGURGITATION


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Prognosis

Rheumatic fever can recur whenever theindividual experience new GABH streptococcalinfection,if not on prophylactic medicines

Good prognosis for older age group & if no

carditis during the initial attack Bad prognosis for younger children & those with

carditis with valvar lesions


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Hypertension:

- Persistent elevation of systolic blood pressure of140mmHg or above and a diastolic pressure of90mmHg or above.(JNC)

Etiology/Risk Factors:

- Age

- Gender

- Genetic

- Lifestyle: Increased Na intake, excessive alcoholconsumption, Increased fat intake, cigarette smoking

- Obesity

- Prolonged or recurrent stress

- DM


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Classification

A. Primary Hypertension also known asessential or idiopathic hypertension

B. Secondary Hypertensionhypertensionsecondary to (caused by) a specific disorder of a

particular organ or blood vessel, such as thekidney, adrenal gland, or aortic artery.

Isolated systolic hypertension - is defined as asystolic pressure that is above 140 mm Hg with a

diastolic pressure that still is below 90. Thisdisorder primarily affects older people and ischaracterized by an increased (wide) pulsepressure.


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White coat hypertension is defined as hypertensionin persons who are actually normotensive except

when their blood pressure is measured by ahealthcare professional.


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ANS imbalance

Increase SNS

stimulation

Adrenal medulla

Cathecholamines

NEP EPbind

Adrenergic receptor

betaalpha

vasoconstrictionInc.HR

Inc.myocardialcontraction

Inc. systemic vascular resistance


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Inc. cardiac workload

Inc Bloodpressure

Dec. blood flowto the kidneys

Release renin fromjuxtraglomerular cellsCatalyzedangiotensinogen

Angiotensin 1

Angiotensin 2

Inc. Na absorption

Inc. H2O absorption

Inc afterload


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Manifestations:

No clinical manifestations other than elevated BP NO signs and symptoms for individual to seek

health care

Most clinical manifestations of HPN is caused by

complications that damage the organs andtissues outside the vascular system


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Evaluation

Diagnosis requires the measurement of bloodpressure on at least 2 separate occassionsaveraging two readings at least 2 minutes apart(140mmHg for SBP and 90mmHg for DBP), withthe patient seated, the arm supported at heartlevel, after 5 minutes rest with no smoking orcaffeine intake in the previous 30 mins.

24 hour blood pessure monitoring

CBC

Urinalysis

Blood chem

ECG


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Stages

BPclassification

SBP DBP Without compellingindication

Normal


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Complications


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Treatment

Lifestyle Changes Follow a Healthy Eating Plan

Therapeutic Lifestyle Changes (TLC).

Dietary Approaches to StopHypertension (DASH) eating plan

Increase Physical Activity

Maintain a Healthy Weight

Medications:

Diuretics Thiazide


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Diuretics - Thiazide

Blood Pressure Lowering Drugs

-Beta-blockers (such as acebutolol, atenolol,metoprolol, nadolol, and propranolol)

-Angiotensin-converting enzyme (ACE) inhibitors(such as benazepril, captopril, enalapril, lisinopril,

and ramipril)-Calcium-channel blockers (such as amlodipine,

felodipine, nifedipine, nicardipine, and verapamil)

-Alpha/beta blockers (such as labetalol)


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Cholesterol-Lowering Drugs

-Statins (such as lovastatin, pravastatin, simvastatin,atorvastatin, and fluvastatin)

Blood Thinning Drugs, Platelet Inhibitors

Aspirinfirst choice platelet inhibitor forpreventing and treating atherosclerosis; reducesrisk of transient ischemic attack (TIA), stroke,

and heart attacks Ticlodipinefor individuals who can not take

aspirin (due to allergies, for example) or do notimprove from aspirin; has more side effects than

aspirin Dipyridamolenot as effective as aspirin when

used alone but may be used in combination withaspirin or warfarin (another blood thinner); oftenused after bypass surgery

Cl id l d i k f h k


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Clopidogrelreduces risk of heart attacks

Glycoprotein IIb/IIIa receptor agonists (such as

abciximab, eptifibatide, lamifiban, andtirofiban)used when awaiting or just followingan angioplasty


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Blood Thinning Drugs, Anticoagulants Heparinused intravenously in the hospital

following a TIA, stroke, or heart attack

Low molecular weight heparinadministered

by self-injection following a stroke or forcoronary artery disease

Warfarinused to prevent stroke inindividuals who have irregular heart rhythms

Blood Thinning Drugs Thrombolytics


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Blood Thinning Drugs, Thrombolytics

The following medications are used in thehospital just after a heart attack. They are most

effective when used within three hours of astroke or heart attack.

Recombinant Tissue Plasminogen Activator(rTPA)

Streptokinase

Urokinase

Other Medications

Nitratesused to relax the vessels that supplythe heart with blood; these medications reducechest pain

Non-surgical techniques


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g q

The following nonoperative techniques may beperformed on individuals with coronary and

peripheral artery disease: Angioplastya procedure used to widen narrowed

arteries. A surgeon inserts a catheter with a deflatedballoon into the narrowed part of the artery. The

balloon is inflated, widening the inner diameter of theblood vessel so blood can flow more easily. Theballoon is then deflated and the catheter is removed.This procedure may also include the placement of a

permanent stent (wire mesh) that holds the arteryopen and improves blood flow. Angioplasty withstent placement is considered the safest and mosteffective procedure for atherosclerosis.

Atherectomy a procedure to remove plaque


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Atherectomya procedure to remove plaquefrom the arteries using a laser catheter or arotating shaver

Laser revascularizationa procedure in which alaser creates multiple channels through the heartmuscle into the main pumping chamber of theheart. These channels fill with blood from the

pumping chamber which then supplies oxygenand needed nutrients to the heart muscle. It isused to relieve severe chest pain in individualswho have no other treatment options.


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Surgical Procedures

Bypass surgerya procedure that reroutes or

bypasses blood around clogged arteries toimprove blood supply to affected areas such asthe heart or the lower extremities

Minimally invasive bypass surgerythis

procedure creates a small incision rather thanthe broad opening in the chest wall createdduring regular bypass surgery

Endarterectomya procedure primarily used to

remove plaque in the carotid (a major arterylocated in the front of the neck) or peripheralarteries


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Peripheral Vascular Disease

Refers to any abnormality in the arteries andveins outside the heart.

Most common sites of atheromas in theperipheral circulation are the abdominal aorta,

femoral and iliac arteries Partial Occlusion impair both muscle activity

and sensory function in the legs

Total Occlusion Loss of blood supply, necrosis,

ulcers and gangrene

Si d m t m


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Signs and symptoms

Increasing weakness and fatigue in the legs Intermittent claudication or leg pain associated

with exercise or walking due to muscle ischemia

Sensory impairment may also be noted as

paresthesia tingling or burning and numbness.

Peripheral pulses distal to the occlusion becomeweak or absent

Appearance of the skin of the feet and legs

changes with marked pallor or cyanosis

Skin is dry and hairless


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Toenails are thick and hard Feel feel cold

Diagnostic test:

Doopler studies

Arteriography

Plethysmography


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Treatment

Reduction of serum cholesterol levels isrecommended

Administration of anticoagulants: Aspirin andHeparin

Cessation of smoking

Exercise

Maintaining a dependent position for the legs animprove arterial perfusion

Care should be taken to avoid trauma and regularexam of the feet is very important to avoidpressure from shoes


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Surgical Treatment: a. bypass graft using a vein or synthetic material

b. Angioplasty

c. Endarterectomy

Gangrenous feet antibiotics and debridement

Amputation

Thromboangiitis Obliterans Raynaud Syndrome(Idiopathic)


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g(Buergers Dse)

y y ( p )

-An inflammatory condition of

medium-sized and small arteries inthe legs and arms-Thrombus forms easily and firosisleads to vascular occlusion-Common in young men before age

35-Aggravated by cigarette smoking-Genetic common in jewish,

japanese and indian origin-*Intermittent caludication

-Ulcerations and gangrene-Amputation

-An example of vasospastic condition

in which periodic temporaryvasoconstriction occurs in thearterioles and small arteries in thesuperficial tissues of the fingers.-Common in young women

-Triggered by exposure to cold

-Ischemia with pallor, numbness andcyanosis followed by vasoconstriction

-Redness and throbbing pain-Instruct patient to protect hands fromtouching cold objects.


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Aneurysms

Localized dilatation in an arterial wall Most common site is the abdominal aorta

3 forms of aneurysms:

A. Saccular projects from one side of the vessel

only B. Fusiform Develops if an entire arterial

segment becomes dilated

C. Dissecting Happens when there is a tear in

the intima, allowing blood to flow along the lengthof the vessel between the layers of the arterialwall.

-serious bec they can rupture leading tohemorrhage and death.


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Etiology

Atherosclerosis most common cause Hypertension

Other infection that affect the arterial wall


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Signs and symptoms

Asymptomatic for a long period of time until theybecome large or rupture.

Once ruptured may cause severe hemorrhage:pain and indications of shock

Treatment:

Surgical repair with resection and replacementwith a synthetic graft can prevent rupture


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Venous Disorder

1. Varicose Veins Are irregular, dilated and tortuous areas of the

superficial or deep veins

Most common location is the legs but they are

also found in the esophagus and rectum.

Varicose vein develops from a defect orweakness in the vein walls or in the valves.


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Signs and symptoms

Superficial varicosities Edema

Shiny

Thrombophlebitis and


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pPhlebothrombosis

Often used interchangeably It is difficult to differentiate the two conditions but

sometimes there is a significant difference in thepredisposing factors

Thrombophlebitis refers to the development of athrombus in a vein in which inflammation ispresent.

Phlebothrombosis a thrombus forms

spontaneously in a vein without priorinflammation, although inflammation may developsecondarily in response to thrombosis

cura mono,rheu,hyper

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