1. Cardiovascular and Respiratory System Disorders
Chapter 40
Cardiovascular and Respiratory System Disorders
Cardiovascular and respiratory system disorders are leading causes of death in the United States.

2. CARDIOVASCULAR DISORDERS
Problems occur in the heart or blood vessels.
With hypertension, the resting blood pressure is too high.
The systolic pressure is 140 mm Hg or higher or the diastolic pressure is 90 mm Hg or higher.
Causes
Narrowed blood vessels
Kidney disorders
Head injuries
Some pregnancy problems
Adrenal gland tumors
Review the Focus on Children and Older Persons: Cardiovascular Disorders Box on p. 658 in the textbook.
Most people have high blood pressure at some time during their lives.
Review Box 40-1 on p. 658 in the textbook for risk factors.

3. Hypertension can lead to: Stroke Hardening of the arteries
Heart attack
Heart failure
Kidney failure
Blindness
Life-style changes can lower blood pressure.
A diet low in fat and salt
A healthy weight
Regular exercise
Not smoking
Limiting alcohol and caffeine
Managing stress and sleeping well
Certain drugs can lower blood pressure.
Pre-hypertension is when the systolic pressure is between 120 and 139 mm Hg and the diastolic pressure is between 80 and 89 mm Hg.
A person can have high blood pressure for many years without knowing it. Hypertension is called “the silent killer.”
Signs and symptoms develop over time. Headache, blurred vision, dizziness, and nosebleeds occur.

4. Coronary artery disease (CAD, coronary heart disease, heart disease)
coronary arteries are in the heart.
In CAD, one or all coronary arteries become hardened and narrow.
most common cause is atherosclerosis.
major complications of CAD are:
Angina
Myocardial infarction (heart attack)
Irregular heartbeats
Sudden death
The more risk factors, the greater the chance of CAD and its complications.
The coronary arteries supply the heart with blood.
With atherosclerosis, plaque collects on the arterial walls. The narrowed arteries block blood flow. Blockage may be total or partial.

5. These risk factors cannot be controlled:
Gender (Men are at greater risk than women.)
Age (Risk increases with age.)
Family history
Race (African-Americans are at greater risk than other groups.)
These factors can be controlled:
Being overweight
Lack of exercise
High blood cholesterol
Hypertension
Smoking
Diabetes
Stress

6. The goals of treatment :
Relieve symptoms
Slow or stop atherosclerosis
Lower the risk of blood clots forming
Widen or bypass clogged arteries
Reduce cardiac events
Persons with CAD:
Quit smoking, exercise, and reduce stress
Eat a healthy diet
If overweight, lose weight
Some may need medications:
Decrease the heart’s workload and relieve symptoms
Prevent a heart attack or sudden death
Delay the need for medical and surgical procedures

7. Persons with complications from CAD may need cardiac rehabilitation.
Exercise training
Education, counseling, and training
The cardiac rehab team includes:
Doctors (the person’s doctor, a heart specialist, a heart surgeon)
Nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or psychiatrists
The person learns how to exercise safely.
The exercise plan is based on the person’s abilities, needs, and interests.
The person learns:
About his or her heart condition
How to reduce the risk of future problems
How to adjust to a new life-style
How to deal with fears about the future

8. Angina (pain)
is chest pain from reduced blood flow to part of the heart muscle (myocardium).
described as tightness, pressure, squeezing, or burning in the chest.
Symptoms can be relieved.
Rest often relieves symptoms in 3 to 15 minutes.
A nitroglycerin tablet is taken when angina occurs.
Some persons have nitroglycerin patches.
Things that cause angina are avoided.
Exercise programs are supervised by the doctor.
Chest pain lasting longer than a few minutes and not relieved by rest and nitroglycerin may signal heart attack. The person needs emergency care.
Angina occurs when the heart needs more oxygen.
Pain can occur in the shoulders, arms, neck, jaw, or back. Pain in the jaw, neck, and down one or both arms is common.
Rest reduces the heart’s need for oxygen. Heart damage is prevented.
Nitroglycerin tablets are kept within the person’s reach at all times. The person takes a tablet and then tells the nurse.

9. Myocardial infarction (MI)
With MI, part of the heart muscle dies.
Sudden cardiac death (sudden cardiac arrest) can occur.
MI also is called:
Heart attack
Acute myocardial infarction (AMI)
Acute coronary syndrome (ACS)
Coronary
Coronary thrombosis
Coronary occlusion

10. CAD, angina, and previous MI are risk factors. MI is an emergency
Relieve pain
Restore blood flow to the heart
Stabilize vital signs
Give oxygen
Calm the person
Prevent life-threatening problems
If the person survives:
He or she may need medical or surgical procedures to open or bypass the diseased artery.
Cardiac rehabilitation is needed.
The area of damage may be small or large.
Signs and symptoms are listed in Box 40-2 on p. 661 in the textbook.
The goals of cardiac rehab are to:
Recover and resume normal activities
Prevent another MI
Prevent complications such as heart failure or sudden cardiac arrest
Review the Focus on Long-Term Care and Home Care: Myocardial Infarction Box on p. 661 in the textbook.

11. Heart failure (congestive heart failure [CHF])
the heart is weakened and cannot pump normally.
the left side of the heart cannot pump blood normally, blood backs up into the lungs.
the right side of the heart cannot pump blood normally, blood backs up into the venous system.
A very severe form of heart failure is pulmonary edema (fluid in the lungs).
When the left side of the heart cannot pump blood normally, respiratory congestion occurs. The person has dyspnea, increased sputum, cough, and gurgling sounds in the lungs. The rest of the body does not get enough blood. Signs and symptoms occur from the effects on other organs.
When the right side of the heart cannot pump blood normally, feet and ankles swell. Neck veins bulge. Liver congestion affects liver function. The abdomen becomes congested with fluid. The right side of the heart pumps less blood to the lungs. Normal blood flow does not occur from the lungs to the left side of the heart. Signs and symptoms of left-sided failure occur.
Pulmonary edema is an emergency.

12. Common causes of heart failure are:
CAD MI
Hypertension
Age
Diabetes
Irregular heart rhythms
Damaged heart valves
Kidney disease

13. Drugs are ordered to strengthen the heart.
Treatment
Drugs are ordered to strengthen the heart.
Drugs are ordered to reduce the amount of fluid in the body.
A sodium-controlled diet is ordered.
Oxygen is given.
Semi-Fowler’s position is preferred for breathing.
The person must reduce the risk factors for CAD.
If acutely ill, the person needs hospital care.
Many older persons have heart failure. They are at risk for skin breakdown. Good skin care and regular position changes are needed.
Review the Focus on Children and Older Persons: Heart Failure Box on p. 661 in the textbook.

14. RESPIRATORY DISORDERS
The respiratory system brings oxygen (O2) into the lungs and removes carbon dioxide (CO2) from the body.
Respiratory disorders interfere with this function and threaten life.

15. Chronic obstructive pulmonary disease (COPD)
Chronic bronchitis, emphysema, and asthma are grouped under COPD.
Risk factors for COPD include:
Cigarette smoking
Pipe, cigar, and other smoking tobaccos
Exposure to second-hand smoke
Not smoking is the best way to prevent COPD.
COPD has no cure.
COPD affects the airways and alveoli.
With COPD, less air gets into the lungs; less air goes out of the lungs.

16. Chronic bronchitis occurs after repeated episodes of bronchitis.
Bronchitis means inflammation of the bronchi.
Smoking is the major cause.
Infection, air pollution, and industrial dusts are risk factors.
Smoker’s cough in the morning is often the first symptom.
Treatment involves:
The person must stop smoking.
Oxygen therapy and breathing exercises are often ordered.
Respiratory tract infections are prevented.
If one occurs, the person needs prompt treatment.
At first, the cough is dry. Over time, the person coughs up mucus. Mucus may contain pus. The cough becomes more frequent.
Mucus and inflamed breathing passages obstruct airflow into the lungs.
The person has difficulty breathing and tires easily.

17. In emphysema, the alveoli enlarge and become less elastic.
Some air is trapped in the alveoli when exhaling.
O2 and CO2 exchange cannot occur in affected alveoli.
Smoking is the most common cause.
Air pollution and industrial dusts are risk factors.
The person has shortness of breath and a cough.
Breathing is easier when the person sits upright and slightly forward.
Treatments
The person must stop smoking.
Respiratory therapy, breathing exercises, oxygen, and drug therapy are ordered.
Trapped air is not exhaled. As more air is trapped in the lungs, the person develops a barrel chest.
At first, shortness of breath occurs with exertion. Over time, it occurs at rest.
Sputum may contain pus.

18. With asthma, the airway becomes inflamed and narrow.
Extra mucus is produced.
Signs and symptoms include:
Dyspnea
Wheezing and coughing
Pain and tightening in the chest
Asthma usually is triggered by allergies.
Sudden attacks (asthma attacks) can occur.
Asthma is treated with drugs.
Severe attacks may require emergency care.
Repeated attacks can damage the respiratory system.
Symptoms are mild to severe.
Other triggers include air pollutants and irritants, smoking and second-hand smoke, respiratory infections, exertion, and cold air.
The person gasps for air and is very frightened. Fear makes the attack worse.

19. Influenza (flu) Influenza is a respiratory infection.
Caused by viruses, flu season is usually from November through March.
Most deaths from flu occur in older persons.
Treatment involves fluids, rest, and relief of symptoms.
Coughing and sneezing spread flu viruses.
Standard Precautions are followed.
The flu vaccine is the best way to prevent the disease.
Review the contents of Table 40-1 on p. 663 in the textbook for the differences between a cold and the flu.
The doctor orders drugs for symptom relief and to shorten the flu episode.
Older persons with lung or heart diseases are at great risk.

20. Are 50 years of age and older
The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for persons who:
Are 50 years of age and older
Have chronic heart, lung, or kidney diseases
Have diabetes
Have immune system problems
Have a severe form of anemia
Will be more than 3 months pregnant during the flu season
Are nursing center or assisted-living residents
Are in close contact with children 0 to 23 months of age
Pneumonia is a common complication.
Review the Focus on Children and Older Persons: Influenza Box on p. 663 in the textbook.

21. Pneumonia Pneumonia is an inflammation and infection of lung tissue.
Affected tissues fill with fluid.
Bacteria, viruses, and other microbes are causes.
Microbes reach the lungs in these ways:
Being inhaled
Aspirated
Carried in the blood
Children under 2 years of age and adults over 65 years of age are at risk.
Older adults are at great risk of dying from the disease.

22. Factors that increase the risk of pneumonia Smoking Aging Stroke
Bedrest
Immobility
Chronic diseases
Tube feedings
Treatment :
Drugs for infection and pain
Increased fluid intake to treat fever and to thin secretions
Intravenous therapy and oxygen
Semi-Fowler’s position to ease breathing
Onset may be sudden. The person is very ill.
Signs and symptoms include high fever, chills, painful cough, chest pain on breathing, rapid pulse, shortness of breath, and rapid breathing. Cyanosis may be present.
Sputum is thick and white, green, yellow, or rust-colored. The color depends on the cause.

23. Standard Precautions are followed.
Rest is important.
Standard Precautions are followed.
Isolation Precautions are used depending on the cause.
Mouth care is important.
Frequent linen changes are needed because of fever.
Review the Focus on Children and Older Persons: Pneumonia Box on p. 664 in the textbook.

24. Tuberculosis (TB) is a bacterial infection in the lungs.
can occur in other parts of the body.
not treated, the person can die.
spread by airborne droplets with coughing, sneezing, speaking, singing, or laughing.
Those who have close, frequent contact with an infected person are at risk.
Risk factors :
Living in close, crowded areas
Age
Poor nutrition
HIV infection
Nearby persons can inhale the bacteria.

25. can be present in the body but not cause signs and symptoms. TB
can be present in the body but not cause signs and symptoms.
Only persons with an active infection can spread the disease to others.
Chest x-rays and TB testing can detect the disease.
Treatment =drugs for TB.
Standard Precautions and Isolation Precautions
The person must cover the mouth and nose with tissues when sneezing, coughing, or producing sputum.
Tissues are flushed down the toilet, placed in a biohazard bag, or placed in a paper bag and burned.
Hand washing is essential.
An active infection may not occur for many years.
Cough and sputum production increase over time. Sputum may contain blood. Chest pain occurs over time.
Review the Focus on Long-Term Care and Home Care: Tuberculosis Box on p. 664 in the textbook.