Com t 3

• a cluster of conditions which occur together and increase your chances of having heart disease, stroke, and diabetes—
• increased blood pressure
• high blood sugar
• excess body fat around the waist
• abnormal cholesterol or triglyceride levels

• *Abdominal Aortic Aneurysm
• Pain is in back or abd
• May palpate pulsatile mass
• only 40% have sx
• Loss of voice/dysphagia

• pain/swelling
• fever/chills
• redness
• *usually have hx of venous insufficiency
• ex: MRSA

• calf swelling
• redness
• pain in calf
• *positive Homan sign (may not be accurate, if +, use doppler to double check)

• Coumadin - (INR btwn 2-3) (normal is 1)
• bedrest
• elevate affected limb
• compression stockings (graduated
• warm moist packs (avoid drying skin)

• *Peripheral Artery Disease
• Peripheral pulses unequal btwn extremities, may need to assess with doppler
• Ankle/brachial index (Ankle systolic/brachial sys ratio)
• Intermittent claudication - sx of atherosclerosis and PAD, aching pain relieved at rest

• Ineffective tissue perfusion
• *recall this is arterial issue, episodic vasospasm of peripheral arteries.
• results in numbness, tingling and burning pain in cold temps
• doesn't cause irreversible tissue injury
• is benign

• CRP = C-reactive protein is lab test that is sensitive marker of vascular inflammation
• Also use Duplex untrasonography

• Promote adequate nutrition: high protein diet, vitamins, calcium, iron and zinc
• Positioning-elevate legs
• *Protein is building blocks for healing, will also get fluid back into venous system

• Check BP after pt has rested for at least 5 mins
• (*30 mins after cigarettes or caffeine)
• Forearm supported at heart level on firm surface, feet on ground
• Correct cuff size
• May need to check frequently if unstable, until stable

• Exercise
• smoking cessation
• Weight loss
• low sodium, low fat diet

Blood lipid panels yearly

• Dietary approach to stop HTN
• 1500 mg sodium
• whole grain 6-8 servings
• fish/dairy instead of red
• legumes, nuts, seeds, 
• F/V 4-5 servings

• Decrease MAP (Mean Arterial Pressure) 20-25% in first hour, BUT don't bring down too fast
• To 160/100 over 6 hrs

• Get pt involved:
• monitor bp
• medications: ABCD (*Ace inhibitors, Beta blockers, Calcium channel blockers, and Diuretic) 
• Teach about fall risk/ortho hypotension
• Watch for hydration w/ diuretic
• may need to check K+ (can cause dysrhythmias)

• (11)
• Hispanics and african am.
• Obesity 
• diabetics
• Age (change in circulatory system)
• Dyslipidemia
• Increased salt
• Other CV issues (CVA, CAD, CHF)
• Smoking (doesn't increase BP, but smoking w/ HTN increases risk for dying)
• Metabolic syndrome
• Sedentary lifestyle
• OSA (Obstructive Sleep Apnea)

• Normal <120/80
• Pre  120-129/80-89
• Stage 1  140-159/90-99
• Stage 2  > or = 160/100
• Goal 104/90 or lower

• *condition that is consequence of previous disease or injury
• retinal blood vessel damage (blurred vision, decreased visual acuity)
• CVA
• Renal failure
• Heart disease

• *Acute coronary syndrome
• 12 Lead EKG

• *the coronary artery is not completely occluded, so pt will have MI is not treated promptly
• Bedrest
• MONA (Morphine, O2, Nitro, ASA)

• Goal is to balance myocardial O2 supply with demand
• treat as an acute coronary episode

• Unstable angina
• cold, clammy skin
• dyspnea
• fatigue
• cyanosis

• Important to ask "What precipitates it?"
• Physical exertion precipitates an attack
• EKG T-wave shows inversion

Ineffective impaired cardiac tissue perfusion

• LDL = less than 100
• Total = less than 200
• HDL = greater than 40 in males, 50 in females
• Triglyceride = less than 150

• manage cholesterol, diabetes, HTN
• tobacco cessation
• Metabolic syndrome

• Complete occlusion of artery leading to ischemia and necrosis
• Cells are deprived of O2, causing ischemia, cellular injury, and eventually death of cell

• obesity
• race
• family hx
• smoking
• HTN
• Diabetes
• Age
• cholesterol levels
• metabolic syndrome

• ABCDD:
• Ace Inhibitors
• Beta Blockers
• Cessation of Smoking
• Diuretics
• Digoxin

• slow progression of HF by decreasing workload of heart and improving ventricular emptying
• SE: cough, hypotension, alter renal function and hyperkalemia

• decrease afterload, affecting both systolic and diastolic HF
• SE: decreased HR, dizziness, fatigue, hypotension, depression

hypokalemia, dizziness, nocturia

• increases force of contraction
• SE: lowers HR, visual disturbance, confusion, anorexia
• *with hypokalemia, effect of dig is enhanced so risk of toxicity

• Ineffective tissue perfusion
• decreased cardiac output
• excess fluid volume
• acute pain
• ineffective breathing pattern

• STAY WITH PT
• Sit them up in high fowler's, let legs dangle over side of bed
• Simple concise infomation
• monitor urine output

• PPICCS
• Cardiogenic shock - hrt can't pump enuf to meet body's needs
• Cardiac tamponade - fluid in pericardial sac
• Intracardiac thrombus - Blood swirling around and creates clot
• sudden death - duh
• Pericardial effusion - lower sys press during inspiration (pulus paradoxus)
• Pulmonary edema - productive cough w pink tinged sputum, SOB, cyanosis, crackles

• Right side isn't pumping and blood is backing up into the body
• S/S: JVD, edema, Ascites, weight gain, fatigue, anorexia, complains of GI distress

• Blood backs up into lungs
• Crackles heard in lungs
• dyspnea on exertion
• SOB
• Orthopena
• CONFUSION
• Pulmonary sx

• MAWDS
• Meds: must continue, maybe rest of life
• Activity: daily, avoid hot/cold extremes
• Weight: daily, report > 2-3 lb/day or 5 lb wk
• Diet: 2 gm sodium, avoid excess fluids
• Symptoms: ortho hypto
• *Recognize s/s of worsening HF: unusual SOB, swelling, increase pillows to sleep, profound fatigue

• Eosinophils will be high (nor 1-4%)
• Basophils may be high? (Nor 0-0.75%)
• Serum tryptase levels 
• Histamine

• Carry epi-pen at all times
• Epinephrine helps prevent release of more histamines, prostaglandins, leukotrines and further progression of reaction

Atopic: severe itching, raw skin, small raised bumps, red scaly patches (TYPE 1)

Contact:  red rash, bump that drain fluids, crusting, itching swelling (TYPE 4)

• Chronic form of muscle pain, many factors that can cause it
• Pain is caused by overstimulation of CNS
• Need to limit caffeine and nicotine
• get reg sleep schedule

• Manage pain
• rest to maximize function 
• maintain ADL's
• increase strength
• deconditioning exercises, PT

• Child may grow out of allergies
• Can do food testing
• Try to find allergens by taking away foods or adding foods to test

• People qualify after pharmacotherapy and avoidance therapy has been tried
• Must be around allergens you can't avoid

• increase function by performing exercises with ROM
• Do whatever to prevent deformities

• no cure
• physical therapy & meds can help slow progression
• Severe cases can be managed w antirheumatic drugs (DMARDS)

• Manage pain
• Maintain/increase strength and function
• home assessment to determine probs with level of ability
• assistive devices and equip

• immune complex forms when antigens bind to antibodies 
• This is then deposited in tissues or vascular endothelium

• PT
• Assistive devices
• NSAIDS
• DMARD (Disease-Modifying Antirheumatic Drugs)
• methotrexate
• Sulfasalazine

heat

• *This is a hardening of connective tissue, inside the sclera. Can affect skin, but on inside affects vessels. etc. 
• Affects L ventricle of heart, resulting in HF
• Progressive kidney failure
• Digestive disturbances, hardening of intestinal mucosa
• Esophagus hardens = dysphagia
• Lungs harden & impede respiration

• *Systemic Lupus Erythematosus
• Fatigue
• "butterfly" rash over nose
• alopecia
• fever
• muscle pain

• Anaphylactic (Type 1)
• AntiBody mediated (Type 2)
• ImmuneComplex (Type 3)
• Delayed (Type 4)

*Remember, types 1-3 are Antibody Mediated! Type 4 is Cell mediated!!!

• Allergic, Anaphylaxis & Atopy:
• Mast cells release large amts of histamine 
• Stridor, angioedema, Hypotension, Hives

• atopic dermatitis
• allergic rhinitis
• extrinsic asthma
• insect stings

• Antibody is where is shouldn't be
• Occurs when IgG or IgM antibody bind to an antigen, leads to cell and tissue damage
• *mistaken identity*

• Goodpasture syndrome
• Graves disease
• Rheumatic Fever
• Transfusion reaction
• Hemolytic anemia
• Myathenia Gravis

"That's a GOOD PASTURE for all the GRAVES. After RHEUMATIC FEVER swept threw, the blood TRANSFUSIONs caused HEMOLYTIC ANEMIA. Oh MY THE GRAVES!"

immune complex formes when antigens bind to antibodies and are deposited in tissues

• lupus
• RA
• farmers lung
• serum sickness

• Occurs 1-3 days after exposure
• mediated by sensitized Tcells
• Macrophages stimulated and work overtime
• s/s: itching, erythema and raised lesions

• contact dermatitis
• MS 
• Type 1 diabetes
• PPD test
• Graft vs host disease

• Apply tourniquet for hemorrhaging
• Aseptic technique in wound care
• Control edema with rigid or soft compression dressing
• Dont put on pillow-cause flexion and contracture of hip
• Turn side to side

• Self care goals: Increase level of function & participation, positive attitude
• Assistive devices - depends on pt condition, balance & weight bearing status

• Pain perceived in amputated section may last for a year
• 60-80% of pt experience soon after surgery
• Acknowledge feelings as real
• Encourage to verbalize
• Strong Opioids!
• Beta blocker may relieve dull, burning discomfort
• Antiseizure meds for stabbing and cramping pain

• Use quadriceps and thighs for lifting
• Avoid lifting more than 1/3 of weight w/o help
• Lift objects close to body with smooth motion
• Body mechanics and posture
• exercise program

• Depends on pt condition, balance and weight bearing status
• Pt usually decides on type
• Increases level of function

• Extremely painful
• Keep elevated to help with pain and keep edema out of foot

• Complications:
• Avascular necrosis (fracture damages vascular system
• DVT's (prevention = hydration & mobility)

• caused by hyperuricemia (excess uric acid)
• Avoid foods with uric acid

Use pillow btwn legs to prevent adduction

• Immobilize in proper alignment
• Control edema - elevation/ice
• Monitor neurovascular status (circ, motion, sensation)
• Treat for shock

• Shock
• Fat embolism - enter bloodstream, occurs 24-72 hrs after. Chest pain, tachycardia, tachypnea, coughing, hypoxia
• Tx is supportive (intubation, fluids, monitoring)

Footcare in diabetes

• dental procedures or invasive procedures should get prophylactic antibiotics... everytime, forever!
• Postpone elective surgery if current infection
• Discontinue catheters and drains ASAP

• Prompt!!
• IV antibiotics
• Support and immobilize joint
• analgesic agents

Strain is muscle or tendon, caused by overuse

Sprain is ligaments or tendons surrounding joint, caused by twisting or hyperextension

• 3rd degree may need surgery, splint, brace or cast
• RICE = rest, ice, compression, elevation
• After 72 hrs heat may be applied intermittently

1st, 2nd, and 3rd degree

• involved tearing of a few muscle fibers
• minor edema and tenderness
• No loss of function

• partial tearing of muscle or tendon
• Loss of strength
• edema
• tenderness and muscle spasm
• eccymosis

• severe muscle or tendon ruptue and tearing involved tissue
• significant pain
• muscle spasm
• ecchymosis
• edema
• loss of function
• seen on MRI