unit 7 cardiovascular, hematologic and oncology disorders chapters 25, 26, 29

Unit 7

Cardiovascular, Hematologic and Oncology Disorders

Chapters 25, 26, 29

Anatomy and Physiology

• Normal cardiac anatomy

Chapter 25Copyright 2007 Thomson Delmar Learning, a division of Thomson

Learning Inc. All rights reserved.25-2

Congenital Heart Defects: Atrial Septal Defects

• Abnormal connection between the right and left atria

• Pathophysiology• Clinical manifestations• Diagnosis• Treatment

– Diuretics for congestive heart failure– Surgical repair



Atrial Septal Defects



Congenital Heart Defect: Ventricular Septal Defect

• Pathophysiology– Blood flows left to right– Heart enlargement– Pulmonary vessel congestion

• Clinical manifestations– Asymptomatic– Congestive heart failure



(continues)

Congenital Heart Defect: Ventricular Septal Defect

• Diagnosis: loud holosystolic murmur• Treatment

– May close by 2 years of age– Surgical repair



Ventricular Septal Defect



Congenital Heart Defect: Patent Ductus Arteriosus

• Incidence and etiology• Pathophysiology: left to right shunt• Clinical manifestations

– Asymptomatic– Congestive heart failure



(continues)

Congenital Heart Defect: Patent Ductus Arteriosus

• Diagnosis– Continuous murmur below left clavicle– X ray

• Treatment– Indomethacin for preterm only– Surgery– Nonsurgical closure



Patent Ductus Arteriosus



Defects with Decreased Pulmonary Blood Flow: Pulmonary Stenosis

• Pathophysiology– Obstruction of blood flow from RV to pulmonary

artery– Increased RV pressure

• Clinical manifestations– Mild to moderate in newborns; can be

asymptomatic in infants– Severe pulmonary stenosis: dyspnea with exertion

and fatigue



(continues)

Defects with Decreased Pulmonary Blood Flow: Pulmonary Stenosis

• Diagnosis• Treatment

– Surgical– Balloon valvuloplasty– Surgical valvuloplasty



Defect with Decreased Pulmonary Blood Flow: Tetralogy of Fallot

• Ventricular septal defect • Pulmonary stenosis• Right ventricular hypertrophy• Overriding aorta• Incidence and etiology• Pathophysiology



(continues)

Defect with Decreased Pulmonary Blood Flow: Tetralogy of Fallot

• Clinical manifestations– Varies with degree of pulmonary stenosis– Cyanotic or without cyanosis


– Surgical correction– Preoperative management– Palliative: modified Blalock-Taussig shunt



Defects that Obstruct Left Ventricular Outflow: Hypoplastic Left Heart Syndrome


– Cardiac transplantation– Palliative surgery



Acquired Heart Disease: Acute Rheumatic Fever

• Incidence and etiology– Strep pharyngitis– Group A streptococci

• Pathophysiology• Clinical manifestations• Diagnosis• Treatment• Nursing management and family teaching



(continues)

Acquired Heart Disease: Kawasaki Disease

• Incidence and etiology• Pathophysiology• Clinical manifestations• Diagnosis• Treatment• Nursing management and family teaching



(continues)

Acquired Heart Disease: Hypertension

• Incidence and etiology• Clinical manifestations• Diagnosis



(continues)

Iron-Deficiency Anemia

• Incidence and etiology • Pathophysiology

– Lack of dietary iron – Chronic intestinal blood loss

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

26-19

(continues)


• Clinical manifestations– Mild

• Asymptomatic

– Moderate • General irritability • Weakness• Lack of interest in play


26-20

(continues)


• Severe – Cardiac murmurs – Congestive heart failure – Pallor – Impaired healing – Thinning hair – Abdominal pain, anorexia – Low-grade fever


26-21

(continues)


• Diagnosis • Treatment

– Infants– School-age children– Pregnant adolescents

• Nursing management


26-22

Sickle Cell Anemia

• Incidence and etiology • Pathophysiology • Clinical manifestations

– Signs and symptoms • Similar to other anemias • Delayed growth • Delayed onset of puberty


26-23

(continues)

Sickle Cell Anemia

– Vaso-occlusive crisis – Hand-foot syndrome – Sequestration crisis – Aplastic crisis



26-24

(continues)

Aplastic Anemia

• Clinical manifestations– Bruising – Vulnerable to infection – Signs and symptoms of anemia – Impaired growth and development – 5% to 10% develop acute myelogenous leukemia


26-25

(continues)

Aplastic Anemia


– Platelet transfusion – Packed red blood cells – Antibiotics if fever is present– Bone marrow transplant – Immunosuppressive therapy

• Nursing management Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

26-26

Disorders of Coagulation: Hemophilia

• Incidence and etiology – Hemophilia A– Hemophilia B – Hemophilia C

• Pathophysiology


26-27

(continues)


• Clinical manifestations – Bleeding episodes – Hematomas – Hemarthrosis– Hematuria – Epistaxis


26-28

(continues)



– Infusions – Replacing missing coagulation factors – Desmopressin


26-29

Immune Thrombocytopenic Purpura (ITP)

• Incidence and etiology – Thrombocytopenia– Purpura

• Pathophysiology


26-30

(continues)

Immune Thrombocytopenic Purpura (ITP)

• Clinical manifestations – Acute onset – Ecchymoses – Petechial rash – 1 to 4 weeks after viral infection – Spontaneous bleeding – Hemorrhagic blisters

• Diagnosis • Treatment • Nursing management


26-31

Cancer Treatment Modalities

• Goals: to rid the body of all malignant cells, thereby curing the cancer

• Surgery• Chemotherapy• Radiation therapy• Bone marrow transplantation• Biologic response modifiers


29-32

Leukemia

• Clinical manifestations – Fever – Bone pain– Pallor– Bruising


29-33

Acute Lymphocytic Leukemia

• Diagnosis:– Bone marrow aspiration (more than 25%

abnormal lymphoblasts) – Lumbar puncture– Chest X ray

• Treatment


29-34

Lymphomas

• Malignancies that arise from the lymphoid system

• Hodgkin’s disease• Non-Hodgkin’s lymphoma


29-35

Neuroblastoma

• A tumor originating from neural crest cells, which are embryologic precursors of the adrenal medulla and sympathetic nervous system

• Clinical manifestations• Diagnosis• Treatments• Nursing management


29-36

Wilms’ Tumor

• Incidence and etiology• Pathophysiology• Clinical manifestations• Diagnosis• Treatment• Nursing management


29-37

Unit 8Respiratory Disorders

Croup

• Croupy or “barking” cough• Inspiratory stridor• Some degree of respiratory distress


24-39

Treatment of Croup

• Nebulized racemic epinephrine• Systemic or nebulized corticosteroids• Fluids, rest, comfort


24-40

Acute Epiglottitis

• Life-threatening bacterial infection• Respiratory distress, fever, sore throat,

dysphagia, drooling, agitation, and lethargy


24-41

Asthma

• Characterized by chronic inflammation, bronchoconstriction, and bronchial hyper-responsiveness

• Wheezing, coughing, and dyspnea• Airways are damaged over time• Classified by severity of symptoms


24-42

Pharmacologic Treatments

• Short-acting inhaled beta-2 agonists• Long-acting inhaled beta-2 agonists• Leukotriene modifiers• Oral antiasthmatics• Methylxanthines• Systemic corticosteroids


24-43

Nursing Management/Nursing Diagnoses

• Risk for suffocation related to airway obstruction

• Ineffective airway clearance related to allergic and inflammatory processes

• Interrupted family processes related to child with chronic illness


24-44

Cystic Fibrosis

• Inherited disorder affecting the exocrine glands

• Alterations in sweat electrolytes and mucus production lead to multisystem damage

• Chronic infection and airway obstruction lead to bronchiectasis, pneumothorax, and cor pulmonale


24-45

Treatments and Nursing Management

• Maximizing lung functioning – Promote the removal of secretions from the

lungs.– Prevent and treat lung infections.– Manage pulmonary complications.


24-46

(continues)


• Medications – Inhaled recombinant human deoxyribo-nuclease

(DNase)– Antibiotics– Pancreatic enzymes and vitamins A, D, E, K


24-47

(continues)


• Chest physiotherapy• Treat asthma• Supplemental oxygen as needed• Dietary supplements


24-48

unit 7 cardiovascular, hematologic and oncology disorders chapters 25, 26, 29

Documents

thomson delmar learning

division of thomson

fatigue chapter

congenital heart defects

atrial septal defects

decreased pulmonary

ventricular hypertrophy

aorta incidence