Cardiac/Vascular Nurse Exam Secrets Study Guide (29 page)

Type I and type II diabetes

Acute complications associated with type I and type II diabetes include diabetic ketoacidosis (type I), nonketotic hyperosmolar coma (type II), hyperglycemia and hypoglycemia. Acute complications need to be addressed immediately; otherwise, individuals are at risk for seizures and/or coma.

Other long-term complications include vascular disease, coronary artery disease, stroke, peripheral vascular disease, diabetic myonecrosis, diabetic retinopathy, diabetic neuropathy, osteoporosis, Alzheimer disease, infections, foot ulcers, and diabetic nephropathy. In an effort to avoid these complications, patients need to comply with blood sugar management and control other environmental risk factors.

In an effort to prevent long-term complications, diabetic patients should undergo yearly physicals and eye examinations, get necessary immunizations, maintain teeth and feet, avoid stress, maintain proper cholesterol and blood pressure levels, and avoid smoking and/or tobacco use.

The prognosis of diabetes depends on the individual patient and the presence of other comorbid conditions. It also depends on an individual’s compliance to lifestyle modifications and pharmacologic management.

Metabolic syndrome

The main complication of metabolic syndrome is cardiovascular disease such as coronary artery disease, congestive heart failure, heart attack, stroke, and sudden death. Another complication in patients diagnosed with metabolic syndrome who have not already been diagnosed with diabetes, is the development of type II diabetes. Most patients diagnosed with metabolic syndrome have abdominal obesity, which puts them at a high predisposition for developing type II diabetes. Patients diagnosed with metabolic syndrome who have comorbid type II diabetes are at a much higher risk for the development of cardiovascular disease.

Patients diagnosed with metabolic syndrome are also at an increased risk for blood clotting abnormalities and peripheral vascular disease.

Patients diagnosed with metabolic syndrome should have their 10-year risk of developing cardiovascular disease calculated by a specialist.

The National Cholesterol Education Program (NCEP) provides a risk calculator of developing cardiovascular disease within the next 10 years.

Individuals with a 10-year risk score more than 20% are considered high risk for developing cardiovascular disease.

Individuals with a 10-year risk score between 10% and 20% are considered moderately high risk for developing cardiovascular disease.

Individuals with a 10-year risk score less than 10% are considered at moderate risk for developing cardiovascular disease.

Individuals with 10-year risk score of zero or 1 percent are considered at low risk for developing cardiovascular disease.

Hypertension

Persistent hypertension is a risk factor for developing complications such as stroke, heart attack, congestive heart failure, aneurysm, aortic dissection, arteriosclerosis, vision loss, and chronic renal failure. Other complications include intracerebral hemorrhage, lacunar infarcts, congestive heart failure, angina, encephalopathy, myocardial infarction, cardiomyopathy, retinopathy, and nephropathy.

The prognosis of hypertension is associated with the blood pressure level and the presence of other comorbid conditions and complications. Untreated hypertension increases the risk of cardiovascular complications, end organ system failure, and mortality. Untreated mild to moderate hypertension, after 8 to 10 years post onset, has been shown to be associated with atherosclerotic disease in 30% of individuals and end organ system damage in 50% of individuals.

Myocardial infarction

Complications associated with myocardial infarction can be acute or develop post acute attack. Complications include recurrent myocardial infarction, congestive heart failure, valve problems, myocardial rupture, myocardial damage, life-threatening arrhythmia, pericarditis, and cardiogenic shock.

The prognosis of individual who experience a myocardial infarction depends on the degree and extent of the attack. It also depends on the presence of underlying comorbid conditions. Prognosis further depends on patient compliance with lifestyle modifications and pharmacologic management post acute attack. Increased prognosis is associated with early reperfusion, preserved left ventricular function, and compliance with short-term and long-term pharmacologic agents.

Stroke

Complications associated with stroke depend on the extent and degree of damage to brain and associated tissues. It also depends on the location of the brain affected by the stroke. Complications include numbness and weakness on 1 side of the body, confusion, slurred speech, difficulty speaking, vision loss, double vision, difficulty walking, dizziness, loss of balance and coordination, pain, memory loss, problems with spatial orientation and swallowing, loss of bladder or bowel function, and perception loss.

Complications of stroke may be improved with physical therapy and/or rehabilitation. Practitioners involved in rehabilitation include psychiatrists, physical therapists, occupational therapists, recreational therapists, and/or speech therapists. Family or loved ones should keep in close touch with a patient who has had a stroke. They should also keep conversations at an adult level using a normal tone of voice and speaking at a comfortable pace.

Approximately 75% of individuals who experienced a stroke are unable to maintain employment. Also, 30% to 50% of individuals who experience a stroke suffer depression.

Peripheral arterial disease

The main complications of peripheral arterial disease include limb ischemia, limb loss, pain, wound infection, poor wound healing, and decreased limb function.

Individuals diagnosed with peripheral arterial disease are at a greater risk of cardiovascular disease, heart attack, stroke, and/or transient ischemic attack than the general population.

Patients with diabetes and peripheral arterial disease are at a higher risk for developing critical limb ischemia, sometimes requiring amputation of affected limbs.

Inflammation

Examples of acute inflammation include acute appendicitis, acute dermatitis, acute infective meningitis, and acute tonsillitis.

Complications of chronic inflammation can lead to prolonged activation of the inflammatory cascade and inflammatory disorders caused by presence of viral or bacterial infections or signaling malfunctions. Chronic inflammation can lead to development of inflammatory disorders such as asthma; autoimmune disease such as lupus, psoriasis and rheumatoid arthritis; bursitis; gout; prolonged inflammation; chronic prostatitis; glomerulonephritis; hypersensitivities such as allergies; myopathies; leukocyte defects; inflammatory bowel disease such as Crohn disease and ulcerative colitis; pelvic inflammatory disease; reperfusion injury; transplant rejection; obesity; and vasculitis.

Pericarditis

The complications of pericarditis include pericardial effusion, arrhythmias, constrictive pericarditis, and cardiac tamponade. Early diagnosis of pericarditis can reduce the risk of developing these complications.

Constrictive pericarditis is permanent thickening of the pericardium, which hinders proper function of the heart muscle. Complications of constrictive pericarditis include swelling of the abdomen and legs as well as shortness of breath.

Cardiac tamponade is accumulation of fluid in the pericardium leading to improper functioning of the heart. The excess fluid does not allow the heart to pump blood effectively and can lead to sudden death if not properly treated.

Pericarditis can range from mild to very severe cases and prognosis depends on the extent and degree of disease. Most cases resolve within 2 weeks to 3 months.

Vasculitis

Complications of vasculitis are dependent on the degree and extent of disease as well as the blood vessels systems and end organ systems involved. Most cases of vasculitis are minor and resolve on their own without medical intervention. However, some cases are severe and involve major end organ systems and result in serious complications. Serious complications include end organ system damage, cardiovascular disease, heart attack, stroke, and death.

Other complications include renal insufficiency, digital gangrene, pulmonary hemorrhage, central nervous system infarction, arterial or venous thrombosis, and subglottic stenosis.

The prognosis of individuals diagnosed with vasculitis depends on the type, extent, and degree of vasculitis as well as end organ involvement.

Endocarditis

Complications associated with endocarditis are dependent on the extent and degree of disease. In more severe cases, where debris and bacteria reside in the endocardium, individuals may experience heart attack, stroke, other end organ system damage, and sudden death. Other complications include arrhythmias, blood clots, brain abscess, brain or nervous system damage, congestive heart failure, glomerulonephritis, jaundice, cardiac valvular insufficiency, aneurysm, cardiac abscesses and severe heart failure.

Untreated endocarditis can be very serious and permanently damage inner lining of heart cambers and valves, leading to congestive heart failure due to an inability of the heart to pump effectively.

The prognosis in individuals who receive early intervention is better for those who receive delayed treatment. However, complications such as heart attack and stroke can lead to sudden death.

Renal artery occlusion

Complications associated with renal artery occlusion include hypertension, chronic renal failure and malignant hypertension. Hypertension associated with renal artery occlusion may be difficult to control and require intervention with multiple pharmacologic approaches including angiotensin-converting enzyme inhibitors such as captopril and enalapril and angiotensin II receptor antagonists such as losartan.

Untreated renal artery occlusion can result in chronic renal failure and potentially death. Although balloon angioplasty and stenting may improve blood flow from arteries of kidneys, blockage may reoccur. Early diagnosis and careful monitoring can prevent progression of the disease and improve outcomes.

Renal vein thrombosis

Renal vein thrombosis typically improves overtime, with limited permanent damage to kidneys and other end organ systems. However, complications that can arise from renal vein thrombosis include acute renal failure if occurring due to dehydration in an infant or adolescent, embolization of blood clot to lungs, heart, brain or other organ systems, and formation of new blood clots.

The prognosis of renal vein thrombosis depends on the degree and extent of the condition and the impact on other organ systems such as the lungs and/or brain. It also depends largely on the extent of renal system damage. The effects on kidney function depend on whether 1 or both kidneys are affected, whether blood flow can be restored and health of the kidney prior to the presence of renal vein thrombosis. Death is typically rare but can occur due to an underlying comorbid condition.

Atheroembolic renal disease

The complications of atheroembolic renal disease are similar to that of atherosclerotic disease. Complications associated with atheroembolic disease include acute renal failure, chronic renal failure, high blood pressure, embolization of blood clots, and formation of blood clots in other organ systems such as heart, intestines, lungs, and legs.

Complications associated with atherosclerosis include risk of blood clotting, in which a plaque increases in size to reduce blood flow and risk of rupture, which can lead to heart attack and/or stroke. If blood flow is reduced to the peripheral vasculature then patients may have walking and dexterity complications, erectile dysfunction and abdominal aortic aneurysms.

Atherosclerosis leads to altered vascular function including coronary heart disease, myocardial ischemia and myocardial infarction, cerebrovascular insufficiency, stroke, aortic aneurysm and vasculitis. The prognosis of atheroembolic renal disease depends on the degree and extent of disease as well as presence of other comorbid conditions. The disease typically progresses overtime and outcomes are generally poor.

Lifestyle modifications may slow the progression of the disease but progression typically occurs.

Marfan syndrome

Complications of Marfan syndrome include aortic dissection due to weakening of the aorta, heart value disease that can lead to enlargement of the heart, mitral valve prolapse, mitral valve regurgitation, endocarditis, optical complications, lung complications such as breathing difficulties, abnormal heart sounds, as well as aortic aneurysm. Aortic aneurysm accounts for the most deaths associated with Marfan syndrome.

Vision complications associated with Marfan syndrome include shifting or dislocation, extreme nearsightedness, glaucoma, cataract and/or detachment or tear in the retina. Skeletal complications include scoliosis, spondylolisthesis, and foot pain. Other complications include stretch marks and dural ectasia.

Pregnant women with Marfan syndrome are at greater risk for aortic dissection or rupture due to increased stress to the aortic walls.

Atrial septal defect

The prognosis for patients with small atrial septal defect is very good, with most living a normal life span without symptoms. However, patients with larger defects may have complications later in life including disabilities due to shunting of blood between atria and increased blood flow in pulmonary circulation.