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Clinical Day 10/12/21 - Coggle Diagram

- - - - Failure of left ventricular pumping ability
        
        Deceased Cardiac output to body
        
        Blood back up into Left atrium
        
        Pulmonary congestion, dyspnea, activity intolerance
        
        Pulmonary edema and right sided heart failure
        
        Right sided HF
        
        1 more item...
  - - - dysrhtymias
      - Cardiomyopathies: HTN, CAD, substance abuse
      - MI
      - Cardiac rhythm changes
  - - - Toxins, ETOH, obesity, HTN
    - - HTN
      - Increased age
      - CAD
      - RHD
      - Tamponade
  - - - beta blockers (metoprolol, Labetalol)
      - diuretics (Furosemide, Hydrocholrolthiazide)
      - aldosterone antagonist (Aldactone, eplerenone, spironolactone)
      - inotropes (Digoxin, Berberine, Catecholamines, Epinephrine
      - digoxin
      - Angiotensin II receptor blockers (Losartan, Valsartan)
      - Ace Inhibitors (Lisinopril, Enalapril)
    - - Coronary bypass surgery
      - heart valve repair or replacement
      - implantable cardiaverter-defibrillator
      - CRT therapy
      - Ventricular assist decices
      - Transplant
- - - - cause neutrophil–endothelial cell adhesion, activate the clotting mechanism, and generate microthrombi
        
        release numerous other mediators, including leukotrienes, lipoxygenase, histamine, bradykinin, serotonin, and IL-2
        
        arteries and arterioles dilate, decreasing peripheral arterial resistance; cardiac output typically increases
        
        Later, cardiac output may decrease, blood pressure falls (with or without an increase in peripheral resistance)
        
        Decreased perfusion causes dysfunction and sometimes failure of one or more organs, including the kidneys, lungs, liver, brain, and heart.
  - - - later extremities become cool and pale
  - - - restoration of perfusion with IV fluids (normal saline) and vasopressors
      - Oxygen support
      - Broad spectrum antibiotics
        
        Parenteral antibiotics ASAP
        
        Vancomycin, Linezolid
      - source control
      - Corticosteroids and insulins
    - - Should monitor hourly
      - CVP, PAOP, ScvO2
      - Pulse oximetry
      - ABGs
      - Blood glucose, lactate and electrolytes
      - Renal function
        
        Monitor urine output
  - - - Treated with pressor therapy
        
        started on vacnomycin
- - - - Biliary stasis
        
        dilation and distention of gall bladder
        
        blood flow and lymphatic drainage compromised
        
        mucosal ischemia and necrosis
    - - Pt presented with idiopathic cholecystitis
    - - Critical illness
        
        PMH of chronic afib, AKI, CKD, CHF, Covid -19,
      - major sugery
        
        Hx of gastic antrectomy, spinal surgery repair, appendectomy, total bilateral knee replacement, hysterectomy (non dated)
      - sepsis
        
        Pt had MSSA of infected spinal hardward and had corrective surgery
      - prolonged fasting
        
        gall bladder does not receive cholecystokinin (CKK)
        
        non stimulus to empty
        
        concentrated with bile, stagnant in the lumen
      - Myocardial infarctions
      - Injury dt retained bile
      - extremely noxious substances
  - - - increases with age
        
        Pt is 79
      - more frequent in females
      - elevated progesterone durning pregnancy
        
        biliary statsis
      - ethnicity: higher in scandinavian decent, pima indians, hispanic population
  - - - Antibiotics
    - - Cholecystectomy
      - Percutaneous cholecysotmy
  - - - Antibiotics (Cipro and Flagyl)
      - Cholecystomy catheter drain placement
    - - WBC trending upward. From 10/5 - 10/12 values are 9.6, 23.5, 13.0, 14.7, 15.4
      - increased alkaline phosphate values from 10/5 to 10/12 are 658,586,515,315,438,292,292
      - normal amylase and lipase
      - Surgical cultures NGTD
    - - distended gallbladder and dilated CBD to 1.4 concerning for distal CBD lesion causing biliary obstruction and cholangitis
      - No evidence of gall stones
      - Hepatic stenosis
- - - - increase risk for stroke, heart attack
  - - - anti- cholesterol medications (statins)
      - protein concertase subtilisin/kexin type 9 (PCSK9) inhibitors
    - - exercise, weight loss, low-fat diet
      - Plasmapheresis (mechanical cleaning of blood of lipids)
- - - - Decrease in BP
        
        decrease perfusion
        
        organ failure dt decrease perfusion and oxygen
        
        Decrease in organ function
        
        Decrease erythropoitein synthesis
        
        Decrease in electrolyte absorption and excretion
  - - - Monitor urine output
      - monitor electrolyte values
      - water intake
  - - - 3.7 on admission date, then 3.4, 3.7, 4.0, 4.2, 3.9 and 3.6
    - - 1.7 on admission data, then 1.6, 1.8, 1.9, 1.8, 1.8, and 1.7
- - - - secreted into blood stream
        
        targets erythroid progenitor cells in bone marrow to make RBC
        
        Incase RBC leads to increase hemoglobin and oxygen caring capacity
  - - - erythropoietin stimulating agent
      - Iron
      - B12
      - Blood transufsion
    - - Diet: foods high in iron, folic acid, B12
  - - - 3.57 on admission then 3.16,2.97,3.39,3.18,2.97,2.83
    - - 10.6 on admission date then labs as followed: 9.5, 9.0, 10.0, 9.5, 8.7, 8.3
    - - 32.4 on admission date then 28.3, 26.6, 30.4, 28.6, 26.8, 25.8
- - - - Hypothyroidism
      - Cushing Disease
      - Polycystic Ovary failure
      - Growth Hormone Deficiency
  - - - anorectic drugs
      - Lipase Inhibitors
      - Appetitive suppressants
    - - Diet modification
      - CAM therapies
      - Increase exercise
    - - Liposuction
      - Gastric restriction (Lap band)
      - Gastic Bypass
- - - - atria beat chaotically and irregular
        
        AV node bombarded with signals trying to get trough to the ventricles
        
        Heart rate range form 100-175 bmp
        
        when atria quiver, blood pools in the atria, increasing the chances of clot formation
    - - Modifiable
        
        Obesity
        
        secondary to hypertension
        
        Alchohol
        
        Stimulants
      - Non modifable
        
        increased aged
        
        CAD
        
        family hx
        
        chronic health condidiotns
    - - Pharmacological
        
        Beta blockers: help slow the HR
        
        Calcium channel blockers
        
        control HR (may be avoided for pt with HF or hypotension)
        
        Antiarrhythmics medications (Flecainide)
        
        Digoxin: control HR at rest, vasodialator
        
        Blood thinners
        
        Warfarin, apizaban, dabigatran, edoxaban, rivaroxabn
      - Non-pharmacological
        
        Electrical cardioversion (shock heart back to normal)
        
        catheter ablation (heat or cold energy applied to heart tissue at AV node to destroy the electrical signaling connection
      - Nursing Intervention:
        
        CMU/Tele unit
        
        measure vitals (especially HR)
    - - Obese
      - Increased resting HR (96bmp, 92 bpm)
      - being treated with Lovenox
    - - Heart palpitations
      - Chest pain
      - Dizziness
      - Fatigue
      - lightheadeness
      - SOB
      - Weakness