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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.
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003243.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003024.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003261.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003041.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003072.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003075.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003079.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003077.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003088.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003106.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000845.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000845.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003106.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003088.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003077.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003079.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003075.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003072.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003041.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003261.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003024.htmhttp://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003243.htm8/4/2019 CURA Mono,Rheu,Hyper
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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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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
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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