Cardiac/Vascular Nurse Exam Secrets Study Guide (17 page)

Pharmacologic agents used to treat stroke include fibrinolytic agents such as alteplase and antiplatelet agents such as aspirin and ticlopidine.

Please note that acute lowering of blood pressure during a stroke is NOT part of the treatment as it is important to maintain perfusion pressure to the brain.

Preventive measures that individuals can take to reduce the risk of stroke include maintaining proper lipid levels, blood pressure, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, exercising regularly, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

The American Heart Association recommends that individuals over the age of 20 undergo risk factor screening, which includes blood pressure measurement, body mass index, waist circumference and cholesterol and glucose monitoring at least every 2 to 5 years.

Prevention involves primary, secondary, and tertiary prevention. Primary prevention involves reduction of risk factors such as smoking cessation and other behavioral measures. Secondary prevention involves reduction of risk factors in individuals at an increased risk for stroke. Tertiary prevention involves reduction of risk factors in individuals who have already experienced a transient ischemic attack or an acute stroke.

Treatment and prevention of peripheral arterial disease

Treatment of peripheral arterial disease involves lifestyle modifications and pharmacologic management. Lifestyle changes including smoking cessation, increased physical activity, and dietary changes, may improve symptoms and complications of peripheral arterial disease.

Pharmacologic agents used in peripheral arterial disease and comorbid conditions include antiplatelet agents, lipid-lowering agents, antihypertensive agents, diabetes agents, anti-thrombolytic agents, and symptom-relief medications. The goal of treatment is to prevent the onset of complications.

Surgical approaches used for patients with peripheral arterial disease and intermittent claudication include angioplasty. Other surgical approaches used for peripheral arterial disease include transcatheter intervention and peripheral vascular bypass.

Lifestyle modifications and pharmacologic management prevent the onset of arteriosclerosis and peripheral arterial disease. Patients should maintain a diet low in sodium and saturated fats, increase potassium intake, increase exercise and physical activity, avoid smoking and tobacco use, lose excess weight, avoidance of illicit drug use, maintain proper lipid levels, maintain proper sugar levels and control complications of diabetes.

Patients with peripheral arterial disease should practice good foot hygiene to prevent the onset of complications such as infections and gangrene. Patients should wash their feet daily and moisturize them, wear thick socks and comfortable shoes, promptly treat fungal infections, trim toe nails, avoid walking barefoot and immediately have sores and open wounds treated.

Treatment of inflammatory disease

The treatment of inflammation and inflammatory disease depends on the organ systems being affected. Treatment options include lifestyle modifications such as diet, exercise and rehabilitation, pharmacologic approaches and surgery. The type of treatment approach depends on patient’s health status, age, extent and degree of disease, presence of other comorbid conditions, medical history, and type of pharmacologic agents already being prescribed.

Pharmacologic agents used include analgesics, anti-inflammatory agents such as nonsteroidal anti-inflammatory agents, corticosteroids, anti-malarial agents such as hydroxychloroquine and other agents including methotrexate, sulfoalanine, leflunomide, anti-tumor necrosis factor medications, cyclophosphamide and mycophenolate. Other pharmacologic agents may be used to treat specific inflammatory conditions affecting specific organ systems.

Prevention of cardiovascular disease with inflammatory biomarkers

Inflammation is an important mechanism present in cardiovascular diseases such as atherosclerosis. In cardiovascular disease, acute phase inflammation occurs in the presence of C - reactive protein. Therefore, screening patients for the presence of C - reactive protein may be a proactive approach to reducing the risk of congestive heart failure, heart attack, and stroke. C-reactive protein may also be a good biomarker in predicting recurrent disease in patients with previous heart attack, stroke, and/or persistent cardiovascular disease. Recent data has demonstrated that the higher the C - reactive protein levels, the higher the risk of heart attack and/or stroke.

Atherosclerosis is actually an inflammatory response to development of lipids in arteries, with every step of atherosclerotic disease responding to inflammatory signaling mechanisms.

Treatment and prevention of pericarditis

Treatment goals

Treatment of pericarditis involves lifestyle modifications, pharmacologic approaches, and surgery. Treatment depends on the extent and degree of pericarditis as well as the patient’s overall health, age, diet, physical activity, and/or presence of other comorbid conditions. In some more mild cases, pericarditis may resolve itself on its own without medical intervention. However, in cases that are more moderate to severe, pharmacologic agents and/or surgical approaches may be used based on the underlying cause of the condition.

Lifestyle modifications may include reduction of physical activity as well as increased rest and relaxation until condition resolves.

Pharmacologic agents and surgical approaches used to treat pericarditis

Pharmacologic agents include anti-inflammatory agents such as nonsteroidal anti-inflammatory agents, narcotics such as morphine, or colchicine, diuretics, antifungals, antibiotics, aspirin, and corticosteroids.

Surgical approaches may be used in severe cases of pericarditis including pericardiocentesis, pericardiotomy, and pericardiectomy. Pericardiocentesis is a procedure that uses a catheter to remove excess fluid from the pericardium. Pericardiectomy involves removal of the entire pericardium. This procedure is typically reserved for patients with constrictive pericarditis.

Prevention of pericarditis

Acute and chronic pericarditis are typically not preventable, but diseases associated with pericarditis are preventable. For example, decreasing the risk of myocardial infarction or regular dialysis in patients with diabetes to avoid uremia will decrease the risk of pericarditis.

Early intervention with pericarditis may prevent onset of complications such as pericardial effusion, arrhythmias, constrictive pericarditis and cardiac tamponade as well as decrease risk for reoccurrence of the condition.

Treatment and prevention of vasculitis

Treatment of vasculitis involves lifestyle modifications, pharmacologic approaches, and surgery. The goal of treatment is to address the underlying cause of the condition and organ systems involved. Early intervention prevents onset of complications.

Pharmacologic approaches include corticosteroids such as prednisone, prednisolone, and methylprednisolone to reduce inflammation; cytotoxic drugs such as azathioprine and cyclophosphamide to suppress inflammation; and nonsteroidal anti-inflammatory agents such as aspirin and ibuprofen to treat mild symptoms. Other pharmacologic approaches used for treatment of vasculitis include anticoagulants such as heparin and enoxaparin; immunodulators such as immune globulin; antibiotics such as trimethoprim-sulfamethoxazole; and stronger anti-inflammatory agents such as methotrexate.

Pharmacologic agents under clinical investigation for the treatment of vasculitis include mycophenolate mofetil, tumor necrosis factor inhibitors, and rituximab.

Typically, vasculitis cannot be prevented but early treatment and maintenance of good health promote better outcomes in patients diagnosed with the condition. Also, compliance with treatment recommendations may prevent reoccurrence and/or delay vasculitis onset if detected early.

In the United States, immunization of hepatitis B is standard of care, which may help to prevent onset of vasculitis. Avoiding IV drug use and unprotected sex decreases the risk of hepatitis C and HIV, thus decreasing the risk of vasculitis.

General preventive measures that individuals can take to reduce the risk of vasculitis and disease complications include maintaining proper lipid levels, blood pressure, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, obtaining adequate vitamin D and calcium, exercising regularly, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

Treatment and prevention of endocarditis

The treatment of endocarditis involves the treatment of the underlying condition leading to endocarditis as well as prevention of further progression of the disease. The main goal is to prevent additional complications associated with endocarditis such as heart attack, stroke, and sudden death.

Pharmacologic agents such as intravenous antibiotics including penicillin, gentamicin, vancomycin, rifampin, and linezolid are used to fight infection and nonsteroidal anti-inflammatory agents to reduce fever, inflammation and associated pain. Most patients are hospitalized initially to receive intravenous antibiotics but will continue oral antibiotics for up to 6 weeks.

Heart valve replacement surgery may be an option for patients experiencing strokes due to the condition, patients with congestive heart failure and evidence of end organ system damage.

Patients at higher risk for endocarditis including those with artificial heart valves, previous endocarditis infection, congenital heart defects, and heart transplant are recommended preventative antibiotics before certain medical and dental procedures.

New 2007 guidelines recommend that patients at high risk for endocarditis undergoing certain dental procedures and procedures involving respiratory tract, infected tissue should be prescribed preventative antibiotics.

Individuals diagnosed with endocarditis should maintain good dental hygiene by brushing teeth, flossing and maintaining gums. They should also avoid procedures that may lead to skin infections including body piercing and tattoos. General preventive measures that individuals can take to reduce the risk of endocarditis and disease complications include maintaining proper lipid levels, blood pressure, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, exercising regularly, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use, especially intravenous drugs.

Treatment and prevention of renal artery occlusion

The treatment of renal artery occlusion depends on the extent and degree of the condition as well as other organ systems involved. In more severe cases, where patients present with renal failure, surgical intervention may be necessary. Another alternative surgical approach is balloon angioplasty or stenting of renal arteries being affected.

Revascularization is an option in patients with bilateral stenosis, stenosis in a solitary functioning kidney and unilateral stenosis with renal insufficiency. Revascularization is also recommended in patients with normal renal function if their degree of stenosis is more than 80% and if the degree of stenosis is 50% to 80% with activation of intrarenal arterial occlusion. In patients who do not meet these criteria, guidelines recommend practicing clinicians to monitor patients over a 6-month period and then reevaluate.

Pharmacologic agents used to treat associated conditions with renal artery occlusion include angiotensin-converting enzyme inhibitors such as captopril and enalapril, angiotensin II receptor antagonists such as losartan and HMG-coenzyme A reductase inhibitors such as atorvastatin.

Smoking cessation can prevent the onset of renal artery occlusion. General preventive measures that individuals can take to reduce the risk of renal artery occlusion and disease complications include maintaining proper lipid levels, blood pressure, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, exercising regularly, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

In an effort to prevent further progression of renal arterial occlusion, practicing clinicians need to follow patients closely monitoring serum creatine levels, blood pressure levels, serum potassium levels, and complete blood counts. Follow-up ultrasound should also be performed and compared to baseline to determine progression.

Treatment and prevention of renal vein thrombosis

Treatment of renal vein thrombosis involves lifestyle modifications, pharmacologic approaches, and possibly surgery to remove occlusion. However, surgery to remove the occluding factor is rarely performed. Lifestyle modifications include bed rest and/or limited activity for a short period to reduce embolization and new clot formation. Anticoagulation therapy is the standard pharmacologic approach for management. However, fibrinolytic agents may also be used to dissolve the blood clot.

Pharmacologic agents used to treat renal vein thrombosis include angiotensin-converting enzyme inhibitors such as benazepril, captopril, enalapril, fosinopril, moexipril, perindopril and lisinopril and angiotensin receptor blockers such as candesartan, eprosartan, irbesartan, losartan, telmisartan, and valsartan.

The goal of treatment is to decrease risk of new clot formation, prevent progression of current clots, as well as prevent embolization of formed clots to other organ systems including heart, lungs, and/or brain.