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Describe the pathophysiology for the following cardiac diseases:
How does CAD lead to HTN, Heart Failure, and MI?
Pathophysiology for HTN, Heart failure, and MI
What are the determinants of BP?
How does increased pressure impact the workload, contractility, Cardia output, pre-load, afterload, and cardiac output
What are some of the compensatory mechanisms that decrease BP in the body?
(Recommendation: Construct tables to complete the below assignment)
Discuss action, indication, contraindications, side effects, adverse effects, and nursing considerations for patients taking medications in the following classification. Use the prototype drug as an example in each of the classifications.
Angiotensin-converting enzyme inhibitors (Captopril)
B-Blockers (Metaprolol)
Angiotensin II receptor blockers (Losartan)
Centrally acting alpha-2 agonists (Catapress)
Direct-acting vasodilators (Nitroprusside)
Calcium Channel Blockers (Diltiazen)
Drugs affecting urinary output (Hydrochlorothiazide, Furosemide, Spironolactone,)
Drugs Affecting coagulation (heparin and Warfarin)
Cardiac Glycosides ( Lanoxin)
Drugs to treat Heart Failure (Digoxin)
Coagulation: Chapter 48
Discuss the process of blood coagulation and clotting. What is the mechanism by which blood clots dissolve? Describe how antiplatelet agents, anticoagulants, low-molecular-weight heparins, thrombolytic agents, antihemophilic agents, and hemostatic agents affect blood clotting.
Many adults and older adults use aspirin daily for antiplatelet benefits. What nursing considerations are essentials when working with these patients? What teaching points are important for patients on antiplatelet therapy?
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1. CAD (Coronary Artery Disease) leading to HTN (Hypertension), Heart Failure, and MI (Myocardial Infarction).
- Explanation for step 1
- CAD is caused by the buildup of plaque in the coronary arteries, which reduces blood flow to the heart. Over time, this can lead to angina, heart attack, and heart failure.
- HTN (Hypertension) results from increased pressure in the arterial system, which puts extra strain on the heart and blood vessels. This can further exacerbate the effects of CAD and increase the risk of heart attack and heart failure.
- Heart Failure occurs when the heart muscle becomes weakened and unable to pump enough blood to meet the body's needs. This can occur as a result of CAD, HTN, or other conditions that affect the heart.
- MI (Myocardial Infarction) is a type of heart attack caused by the sudden loss of blood flow to a part of the heart, usually due to a blocked coronary artery. This can result in permanent damage to the heart muscle and increase the risk of heart failure. Comprehensive Understanding of Pathophysiology Essay Discussion Paper
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Step 2/8
2. Determinants of BP (Blood Pressure)
- BP is determined by several factors including cardiac output (the amount of blood the heart pumps per minute), blood volume, and resistance to blood flow (afterload).
Step 3/8
3. Increased Pressure Impact on Workload, Contractility, Cardiac Output, Pre-load, Afterload, and Cardiac Output.
- Explanation for step 3
- Increased BP can increase the workload on the heart, making it pump harder to circulate blood throughout the body.
- This can lead to reduced contractility, which is the heart's ability to contract and pump blood effectively.
- As a result, cardiac output can decrease, which can further exacerbate the effects of heart failure.
- Increased BP also increases afterload, which is the resistance the heart faces as it pumps blood out into the arteries.
- This increased resistance can further reduce cardiac output and lead to heart failure.
Step 4/8
4. Compensatory Mechanisms that Decrease BP in the Body
- The body has several compensatory mechanisms to reduce BP, including reducing blood volume and increasing urine output to reduce blood volume.
- The renin-angiotensin-aldosterone system is activated in response to decreased blood flow and decreased blood pressure, which results in increased production of the hormone angiotensin II.
- This hormone causes the blood vessels to constrict, which increases blood pressure, and also stimulates the adrenal glands to produce aldosterone, which increases blood volume and pressure.
- The baroreceptor reflex, which senses changes in blood pressure, also triggers the release of other hormones such as nitric oxide and vasopressin, which dilate blood vessels and reduce blood volume, respectively.
Step 5/8
Angiotensin-converting enzyme inhibitors (Captopril)
Action: Captopril blocks the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor and increases blood pressure. This decreases the blood pressure and improves blood flow.
Indication: Captopril is indicated for the treatment of hypertension, heart failure, and myocardial infarction.
Contraindications: Captopril is contraindicated in patients with a history of allergic reactions to the drug and in patients with a history of angioedema.
Side Effects: Common side effects of captopril include dizziness, headache, fatigue, cough, and diarrhea.
Adverse Effects: Captopril can cause hypotension, hyperkalemia, and kidney dysfunction.
Nursing Considerations: Patients taking captopril should be monitored for hypotension and signs of kidney dysfunction. The drug should be discontinued if the patient develops a rash or other signs of an allergic reaction. Patients should also be advised to avoid taking potassium supplements or potassium-rich foods.
B-Blockers (Metoprolol)
Action: Metoprolol is a beta-blocker that blocks the effects of epinephrine and norepinephrine on the heart and blood vessels. This decreases heart rate and blood pressure, reducing the workload on the heart.
Indication: Metoprolol is indicated for the treatment of hypertension, angina, and heart failure.
Contraindications: Metoprolol is contraindicated in patients with severe bradycardia, heart block, and asthma.
Side Effects: Common side effects of metoprolol include dizziness, fatigue, and bradycardia.
Adverse Effects: Metoprolol can cause hypotension, bronchoconstriction, and worsening of heart failure.
Nursing Considerations: Patients taking metoprolol should be monitored for hypotension and signs of bronchoconstriction. The drug should be discontinued if the patient develops a rash or other signs of an allergic reaction. Patients should also be advised to avoid sudden changes in position, as this can cause dizziness. Comprehensive Understanding of Pathophysiology Essay Discussion Paper
Step 6/8
Angiotensin II receptor blockers (Losartan)
Action: Losartan blocks the effects of angiotensin II on the blood vessels and heart. This decreases blood pressure and improves blood flow.
Indication: Losartan is indicated for the treatment of hypertension, heart failure, and diabetic nephropathy.
Contraindications: Losartan is contraindicated in patients with a history of allergic reactions to the drug and in patients with liver disease.
Side Effects: Common side effects of losartan include dizziness, headache, fatigue, and cough.
Adverse Effects: Losartan can cause hypotension, hyperkalemia, and kidney dysfunction.
Nursing Considerations: Patients taking losartan should be monitored for hypotension and signs of kidney dysfunction. The drug should be discontinued if the patient develops a rash or other signs of an allergic reaction. Patients should also be advised to avoid taking potassium supplements or potassium-rich foods.
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Step 7/8
Centrally acting alpha-2 agonists (Catapres)
Action: Catapres decreases the activity of the sympathetic nervous system, which decreases heart rate and blood pressure.
Indication: Catapres is indicated for the treatment of hypertension.
Contraindications: Catapres is contraindicated in patients with a history of allergic reactions to the drug and in patients with depression
Step 8/8
Blood coagulation and clotting are a complex process that helps prevent bleeding. The process starts with the activation of platelets, which release chemicals to initiate the coagulation cascade. This cascade leads to the activation of clotting factors and the production of a fibrin mesh that eventually forms a clot. The clot acts as a physical barrier to stop bleeding.
- Explanation for step 8
Blood clots dissolve through a process called fibrinolysis, which is the degradation of the fibrin mesh. This is achieved through the action of plasmin, an enzyme that breaks down the fibrin.
Antiplatelet agents, such as aspirin, prevent platelets from clumping together and forming clots. Anticoagulants, such as warfarin, interfere with the coagulation cascade by reducing the activity of clotting factors. Low-molecular-weight heparins, such as enoxaparin, also interfere with the coagulation cascade but have a quicker onset of action and a shorter half-life compared to warfarin.
Thrombolytic agents, such as alteplase, are used to dissolve clots that have already formed. They work by breaking down the fibrin mesh and increasing plasmin activity. Antihemophilic agents, such as factor VIII, are used to treat bleeding disorders by replacing missing clotting factors. Hemostatic agents, such as tranexamic acid, work by blocking the degradation of clots, thereby helping to stabilize clots and stop bleeding.
When working with patients who use aspirin for antiplatelet therapy, nursing considerations include monitoring for bleeding, such as epistaxis or bruising, and monitoring for adverse effects such as gastrointestinal upset or allergic reactions. Teaching points for patients on antiplatelet therapy include the importance of not skipping doses and notifying their healthcare provider of any new or unusual bleeding. They should also avoid nonsteroidal anti-inflammatory drugs (NSAIDs), as these can increase the risk of bleeding.
Final answer
In conclusion, various diseases related to the heart and blood circulation require a comprehensive understanding of their pathophysiology and the use of various medications for treatment. Cardiac diseases such as CAD, HTN, and MI can lead to heart failure due to the impact on workload, contractility, cardiac output, pre-load, afterload, and cardiac output. Comprehensive Understanding of Pathophysiology Essay Discussion Paper
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