Introduction

1. HYPERTENSIVE ATHEROSCLEROTIC CARDIOVASCULAR DISEASE

Hypertensive Atherosclerotic Cardiovascular Disease is an arterial disease in which chronic high blood pressure is the primary cause. It is the association of two
separate diseases, the first being hypertension and the other Atherosclerosis. Atherosclerosis is the progressive buildup and hardening of fatty materials such as cholesterol
within the arterial wall. Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated.
Signs and Sy!tos
Fatigue
Irregular pulse or palpitations
Swelling of feet and anles
!ausea
"loating and abdominal pain
#reater need to urinate at night
Ris" #actors
$levated Cholesterol
Diabetes
Hypertension
Diagnostic T$sts
C% Scan
Co!%ications
Coronary Artery Disease
Heart Attac
Stroe
%ransient ischemic Attac
&eft 'entricular hypertrophy
Congestive Heart Failure
Hypertensive cardiomyopathy
Heart Failure
Heart Attac
&anag$$nt
$ating foods low in fat, cholesterol, and salt
(edications for managing hypertension
Surgery
Having ideal bodyweight
Have a healthy lifestyle
Have health chec)ups
'. DIA(ETES &ELLITUS Ty!$ II
%ype II Diabetes mellitus, formerly nown as noninsulin)dependent diabetes mellitus, is a metabolic disorder wherein there is elevated blood glucose level related to
the insulin resistance and insulin deficiency.
Signs and Sy!tos
*olyuria
*olydipsia
*olyphagia
+eight loss
"lurred vision
Fatigue
Ris" #actors
*eople aged ,, or over
*eople aged -, and over who are *acific Islanders, (aori, Asian
*eople aged ., and over who are obese or overweight, have high blood pressure or have a first)degree relative with type / diabetes
"eing overweight or obese, especially around the waist
Co!%ications
Ischemic heart disease
Stroe
Diabetic etoacidosis 0D1A2
Coronary artery disease
*eripheral 'ascular disease
!erve damage 0neuropathy2
1idney damage 0nephropathy2
3steoporosis
Diagnostic T$sts
Capillary "lood #lucose 0C"#2 monitoring
Tr$at$nt ) &anag$$nt
$ating a healthy diet
$4ercise
&ose weight
"lood sugar monitoring
Insulin %herapy
(edications
*. CHRONIC +IDNEY DISEASE
Chronic idney disease 0C1D2, also nown as chronic renal disease, is a progressive loss of renal function over a period of months or years with #F5 of less than 67
ml8min for - months or longer. %he symptoms of worsening idney function are unspecific, and might include feeling generally unwell and e4periencing a reduced
appetite. 3ften, chronic idney disease is diagnosed as a result of screening of people nown to be at ris of idney problems, such as those with high blood pressure or
diabetes and those with a blood relative with chronic idney disease.
S%A#$ #F5
Stage 9
1idney damage within normal or decreased
#F5
(ore than or e:ual to ;7 m&8 min89.<- m/
Stage /
(ild decrease in #F5
67)=; m&8 min89.<- m/
Stage -
(oderate decrease in #F5
-7),; m&8 min89.<- m/
Stage .
Severe decrease in #F5
9,)/; m&8 min89.<- m/
Stage ,
1idney failure 0$nd)Stage renal disease
$S5D2
&ess than 9, m&8 min89.<- m/
%he >#F5 level,> or glomerular filtration rate, is a measure of how well your idneys are cleaning your blood. %he normal #F5 is 9/, m&8 min89.<- m/.
In Stage 9 and Stage / C1D, there are often few symptoms. $arly C1D is usually diagnosed when there is?
High blood pressure
Higher than normal levels of creatinine or urea in the blood
"lood or protein in the urine
$vidence of idney damage in an (5I, C% scan, ultrasound, or contrast @)ray
A family history of polycystic idney disease
In Stage - C1D, anemia 0a shortage of red blood cells2 and8or early bone disease may appear and should be treated.
+hen C1D has progressed to Stage ., itAs time to begin preparing for dialysis and8or a idney transplant.
C,ronic R$na% #ai%ur$
) is a progressive irreversible deterioration in renal function
) corresponds to chronic idney disease stages -),
Stages of Chronic 5enal Failure
9. 5educed 5enal 5eserve
) CharacteriBed by .7C to <,C loss of nephron function
) *atient usually does not have symptoms because remaining nephrons are able to carry out normal functions of the idney.
/. 5enal insufficiency
) <,C);7C of nephron function is lost
) At this point, serum creatinine and "D! rise, and the idney loses its ability to concentrate urineE
anemia may also develop along with polyuria and nocturia.
*. End-stag$ r$na% dis$as$ .ESRD/
) &ess than 97C nephron function remaining
) 1idney functions are severely impaired
) Dialysis is usually indicated
Signs and Sy!tos
Some signs of chronic renal failure are more obvious than others. %hese are?
increased urination, especially at night
decreased urination
blood in the urine 0not a common symptom of chronic renal failure2
urine that is cloudy or tea)coloured
3ther symptoms arenAt as obvious, but are a direct result of the idneysA inability to eliminate waste and e4cess fluid from the body?
puffy eyes, hands, and feet 0called edema2
high blood pressure
fatigue
shortness of breath
loss of appetite
nausea and vomiting 0this is a common symptom2
thirst
bad taste in the mouth or bad breath
weight loss
generaliBed, persistent itchy sin
muscle twitching or cramping
a yellowish)brown tint to the sin
As the idney failure gets worse and the to4ins continue to build up in the body, seiBures and mental confusion can result.
Some of these complications may include?
anemia
high blood pressure 0hypertension2
increased ris of bleeding
increased ris of infection
fluid overload 0called edema2
dehydration
electrolyte abnormalities 0e.g., hyperkalemia, high levels of potassium in the blood2
mineral abnormalities 0e.g., hypercalcemia 0high levels of calcium in the blood2 or hyperphosphatemia 0high levels of phosphorus in the blood22
brittle bones
malnutrition
seiBures
Ris" 0actors
High blood pressure.
High blood sugar 0diabetes2
1idney diseases and infections
&ead poisoning.
&ong)term use of medicines that can damage the idneys.
T$sts t,at $asur$ "idn$y 0unction
Creatinine
#lomerular filtration rate 0#F52
*ercent idney function
&$dica% &anag$$nt
Conservative therapy is attempted before maintenance dialysis begins
%he goals of conservative therapy are to preserve e4isting renal function, treat clinical manifestations and prevent complications.
Chronic idney disease is usually caused by another condition. So the first step is to treat the disease that is causing idney damage.
1idney disease is a comple4 problem. Fou will probably need to tae a number of medicines and have many tests. %o stay as healthy as possible, wor closely with
your doctor. #o to all your appointments, and tae your medicines Gust the way your doctor says to.
&ifestyle changes are an important part of your treatment. %aing these steps can help slow down idney disease and reduce your symptoms. %hey may also help
with high blood pressure, diabetes, and other problems that mae idney disease worse.
Follow a diet that is easy on your idneys. A dietitian can help you mae an eating plan with the right amounts of salt 0sodium2 and protein. Fou may also need to
watch how much fluid you drin each day.
(ae e4ercise a routine part of your life. +or with your doctor to design an e4ercise program that is right for you.
Do not smoe or use tobacco.
Do not drin alcohol.
P,araco%ogic T,$ra!y
For hyperalemia
5egular insulin administration I'
Sodium bicarbonate
Calcium gluconate I'
Sodium polystyrene aye4alate
Dialysis
For hypertension
Diuretics i.e. furosemide 0&asi42
"eta)adrenergic blocers
Calcium channel blocers
AC$ inhibitors and Angiotension 5eceptor "locers
For hypocalcemia
It is important that serum phosphate level is lowered before administering calcium or 'itamin D because these drugs may contribute to soft tissue calcification if
both calcium and phosphate levels are elevated
Supplemental 'itamin D
For Anemia
$rythropoietin i.e. epoetin alfa 0$pogen2 is produced and available for treatment of anemia
A common adverse effect is the acceleration of hypertension probably due to increased blood viscosity
For Dyslipidemia
H(#)CoA reductase inhibitors or statins
Fibrates are the most effective drug available for lowering triglycerides and can also increase HD&
!utritional %herapy
*rotein 5estriction
Administration of eto)analogues
For +ater 5estriction
o #enerally, 677 ml plus an amount e:ual to the previous dayHs urine output is allowed for a patient with C1D who is not receiving dialysis
o Foods that are li:uid at room temperature, i.e. gelatin, ice cream, should be counted as fluid intae
o Fluid allotment should be spaced throughout the day so that the patient does not become thirsty
1. CO&&UNITY AC2UIRED PNEU&ONIA

It is the inflammation of the lung parenchyma that is caused by microbial agents. It is an inflammatory process involving the respiratory bronchioles, alveolar space and
walls, and lobes, caused primarily by chemical irritants or by specific bacterial, viral, fungal, mycoplasmal or parasitic. %his is the most common type of pneumonia which
occurs in the community or within 8before .= hours upon hospitaliBation.
Ris" #actors
children younger than / years old
people older than 6, years old
*atient with asthma or C3*D
Immunosuppressed clients
Smoing, malnutrition, and air pollution
*atients on ventilator
Intubation and immobility
Signs and Sy!tos
Fever, sweating and chills
Cough with thic and sticy phlegm
Chest pain when breathing deeply or coughing
Difficulty of breathing
Shortness of breath
fatigue and muscle aches
!ausea, vomiting or diarrhea
headache
Stag$s
9. Hyperemia8 Congestion? increased blood flow and capillary permeability due to inflammatory reaction. Infection spreads to neighboring tissues
/. 5ed HepatiBation? massive dilatation of capillaries, and alveoli are filled with organisms, neutrophils, 5"CHs and fibrin
-. #ray HepatiBation? +"CHs coloniBe the infected part of the lung. Febrin deposits accumulate throughout the area of inGury and phagocytosis of cell debris occurs
.. 5esolution? Cell debris, fibrin, and bacteria are digested by macrophages, the clean up cells of the inflammatory reaction, dominate.
Diagnosis
Chest @)ray
History of recent respiratory trac infection
"lood test
Sputum culture test
Co!%ications
Sepsis
"acteremia
&ung abscess
*leural $ffusion
Secondary Infection
Atelactasis
&anag$$nt
Improving airway patency
$ncourage hydration? fluid intae 0/ to - &8day2 to loosen secretions
*rovide humidified air using high)humidity face mas
$ncourage patient to cough effectively, provide correct positioning, chest physiotherapy, and incentive spirometry
Assess for signs and symptoms of shoc and respiratory failure 0e.g vital signs, pulse o4imetry,etch.2
Administer intravenous fluids and medications and respiratory support as ordered
Instruct patient to continue taing antibiotics until completed.
3. SEPSIS

Sepsis is a condition in which the body is fighting a severe infection that has spread via the bloodstream. Chemicals released into the blood to fight infection trigger
widespread inflammation. Inflammation may result in organ damage. "lood clotting during sepsis reduces blood flow to limbs and internal organs, depriving them of
nutrients and o4ygen. In severe cases, one or more organs fail. In the worst cases, infection leads to a life)threatening drop in blood pressure, called septic shoc. %his can
:uicly lead to the failure of several organs )) lungs, idneys, and liver )) causing death.
Signs and Sy!tos
"ecause sepsis can begin in different parts of the body, it can have many different symptoms. 5apid breathing and a change in mental status, such as reduced alertness
or confusion, may be the first signs that sepsis is starting. 3ther common symptoms include?
Fever and shaing chills or, alternatively, a very low body temperature
Decreased urination
5apid pulse
5apid breathing
!ausea and vomiting
Diarrhea
Ris" #actors
'ery young people and elderly people
Anyone who is taing immunosuppressive medications 0such as transplant recipients2
*eople who are being treated with chemotherapy drugs or radiation
*eople who have had their spleen surgically removed 0the spleen helps fight certain infections2
*eople taing steroids 0especially over the long term2
*eople with longstanding diabetes, AIDS, or cirrhosis
Someone who has very large burns or severe inGuries
*eople with infections such as
o pneumonia,
o meningitis,
o cellulitis,
o urinary tract infection
Diagnostic T$sts
"lood wors such as C"C etch
"lood culture
&umbar tap
3ther tests may include a chest @)ray to loo for pneumonia or a C% scan to see if there is infection in the abdomen.
A dye 0contrast2 might be inGected into a vein during a C% scan to help highlight certain organs in the abdomen.
%he C% scan is a series of @)rays taen from different angles very :uicly and put together by the computer to show an image of the internal
organs.
Dsually, a radiologist reads the results and notifies the patientAs doctor.
o In the hospital, the patient may be placed on a cardiac monitor, which will show the patientAs heart rate and rhythm.
o Similarly, the patient is usually placed on a pulse o4imeter which indicates the amount of o4ygen in the blood.
Tr$at$nt and &anag$$nt
%he patient will liely be administered o4ygen, either by a tube that is placed near the nose or through a clear plastic mas.
Depending on the results of the tests, medications may be ordered. %hese medications may include antibiotics given intravenously 0given directly into the vein2.
Initially, the antibiotics may be those that ill many different bacteria because the e4act ind of infection the patient has is not nown. 3nce the blood culture
results show the identity of the bacteria, the doctor may select a different antibiotic that ills the specific organism responsible for the infection.
I' salt solution 0saline2 and medications to increase the blood pressure if it is too low.
If results show an infection in the abdomen, either drainage of the infection by the placement of tubes or surgery may be necessary.
Symptomatic treatment