Cardiovascular Respiratory Disorders Program Transcript

[Pages:5]Cardiovascular Respiratory Disorders

Cardiovascular Respiratory Disorders Program Transcript

ELISABETH BUCHANAN: Hello, everyone. My name is Dr. Buchanan, and this is Advanced Pathophysiology-- Nursing 6501. We're in week three, studying cardiovascular and respiratory disorders. Some reminders for this week. We want to make sure that you understand that the knowledge check is something that needs to be done by the end of day seven in week three. These knowledge checks are to enhance your learning and promote better understanding for your midterm and your final exam.

Remember, you can start and stop these knowledge checks during any part of the week of the assignment. However, remember and remind yourself, they are due on day seven. These knowledge checks are two to four sentences, some can be two to four paragraphs. And they're both acceptable, and whatever works for you, as a reminder, and to help you study.

The one thing that I do want to tell you is, as long as you're understanding what it is. We so many times talk to our patients, and we're, let's say, explaining the HDL factor-- why is HDL a good thing for us? How do we get the HDL to rise if we have a poor lab reading? A patient doesn't want three to four paragraphs, correct? Two to four sentences, and the patient would probably better understand.

But better than that, would be information, or pictorials, or tools, for the patient to take it home, put it on the fridge, and say, this is what I need to eat for my HDL. So in a roundabout way what I'm saying is, make sure that you're not writing a book on these questions. Make sure it's clear, concise, and to the point. These are your study tools. They're not something that we are going to make sure your APA formatted in. We want them to be beneficial to you.

Some of the topics that we're going to study in this week, that you'll be looking at, will be myocardial infarction, endocarditis, myocarditis, valvular disorders, lipids, coags, deep veins, hypertension, COPD, asthma, and pneumonias. The one thing that you want to look at is, the cardiovascular and the respiratory system are very much related, and in a sense, they're married.

What do I mean by that? Without one, you don't have the other. So the myocardial infarction is one of the things that we look at daily. And a lot of patients that come into you and they say, I have chest pain. So, given that chest pain, tell me what it is that you would look at. What are some modifiable risk factors? What would you do right away, if somebody came into your office and they had chest pain? What would you look for? What would be a first diagnostic tool that you would get out?

Probably, most assuredly, you'd do an EKG after you listened and ausculated. If we look at some quick statistics here, we're going to look from the CDC, from 2014, 2015. The CDC has actually studied, stats have come back-- one person dies every 36

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seconds. That's a lot. 665,000 die annually, with one in every four deaths leading to myocardial infarction.

The kicker is-- $219 billion annually. So when you look at $219 billion annually, and I said that's the kicker-- the kicker of that is, how many patients are dying needlessly? How many patients are not compliant? How many patients do we have all of these topics here under discussion, but yet, we don't give those topics of information to the patient?

Knowledge is certainly power for these patients, in any disease or disorder. Remember, in order for the patient to own their disease, they have to understand their disease. If they don't understand it, they're never going to own it. And therefore, when you talk to somebody about these modifiable risk factors that are associated with myocardial infarction, or any of the diseases in general-- you know, COPD, you don't want a high volume of sodium as well, hypertension, you don't want high sodium. So low fat, low cholesterol little sodium, is what we always tell them.

But what you want to look at is, are we giving them the DASH diet so they understand it? Are we giving them the DASH diet, and knowing they're diabetic, can they do the DASH diet? Are we giving them the DASH diet and telling them no added sodium-- so things that they see at the store in the freezer section, and the potato chip section says no added sodium, so that's OK, that's what they get-- no, that's not true.

So what you want to make sure and remember, is be precise. And if you need any referral sources for a dietician, you need to give them pictorials, you need to have them talk to your nurses. Whoever it is that you can help them, so that they own their disease, would be wonderful.

The other thing that you also need to look at, pictorials are great. I use them a lot. A lot of people will read diets, and give them, and hand them out, and it's 12, 1500, ADA diet, low fat, low cholesterol, low sodium. However, have you ever considered the literacy level of your patients? Their understanding? The bullet points that are on those diets, have you ever asked them if they understood it?

You will be surprised how many have a literacy level disability. And even if they didn't, do they understand when you start talking your health care language to them? When you say a DASH diet, what does that mean? When you say, sedentary lifestyle, what does that mean? When you say, no added sodium, what does that mean?

Let's talk about lipids for a little bit. So we know that lipids are affected by all ages, in a sense. We're looking at those under 17, and we're also looking at lipid over the age of 17. And when you look at the lipid profiles on individuals, the one thing that you want to look at is, you want to ask yourself, what is it that they are doing with their diet, that we can help them with, so that they understand?

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If we look at total cholesterol numbers-- and these will be posted in announcements, or you can go on the website, the American Heart Association. You can also go into the JNC8. There's going to be a link that will be posted in announcements for that as well. I have it here. It'll be in these PowerPoints here. You can click on that, and go directly to the link, and look at the hypertensive algorithm. And also intertwined in there is going to be the lipid profile.

So going back to some of our topics. Let's talk about lipids for a little bit. So total cholesterol desirable level is less than 200 for those greater than 18, or equal to. 2 to 17 years of age is less than 170. Borderline is 200 to 239-- borderline high, I'm sorry. Borderline high for 2 to 17 is 170 to 199.

So the borderlines-- I don't even worry about the borderlines, because it's either one or the other. If you tell your patient borderline, and you give them a metformin, or you give them a hypertensive medicine, or you give them a cholesterol, or hyperlipidemia medicine, what's the very first thing they're going to say to everybody? I'm borderline, but here's my medicine, right? So either it either is or it isn't.

We can travel on the line of borderline-ness as our practice, but to say that to the patients, it either is or it isn't. You're going to confuse them if you put them on that borderline scale. So desirable is less than 170. High is greater than 200 for those that are 2 to 17.

Total cholesterol greater than or equal to those of 18 should always be less than 200. Now, greater than 240 is going to be high. HDL cholesterol should be 40 or greater in all age spectrums. How do they get it? Leafy greens. They get it from almonds. Now when we say almonds or nuts, we don't mean those that are sugar coated with cinnamon. We don't mean the Christmas nuts. We don't mean any of that stuff-- plain, un-roasted almonds.

They can put it in a shake, eat six to eight of them a day. They can eat greens. There's a lot of power foods out there they can get to actually help that HDL. You take that HDL minus the total cholesterol-- and let's say they're a 240 and they have a 40 HDL-- then you most certainly can deduct that. And then they're left with a 200 cholesterol.

However, remember, we want the marker less than 200. Their LDL should be less than- the desirable would be less than 100 for those 18 years of age and older. Less than 110 for 2 to 17 years of age. And high is greater than 130 on 2 to 17 years of age, and greater than 18 equal to, or that of, is greater than 160.

Now we want to look at less than 100. That sounds better for us, right? But if my patients are in the 130, it's still high. It's still considered-- there's that borderline mark, right? However, less than 100, greater than 160, and it really depends on your patients. What are you looking at? Do they have a lot of coronary artery disease? Do they have stents? What's going on with them? Always ask all of those topics.

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Triglycerides. Triglycerides are affected by those that drink alcohol, also those that have diabetes that are out of control. A lot of these are congenitals, and you'll hear they'll have a familial history of cholesterolemia. However, regardless, it's in front of you. The numbers are there. Just treat it.

We do care that we have a familial tree that we actually have. However, the moment is now. The patient needs you now. They don't want to discuss, most of the time, their family history. Some don't even know it. So treat the numbers now.

Triglycerides, what we're looking at is acceptable range is anything less than 150 for those that are 18 years of age or older. High is greater than 200. And then I could give you the numbers of pediatric, which are 0 to 9 years of age IS greater than 100 is high, acceptable and 0 to 75. 10 to 17 years of age and older is less than 90, greater than 130.

Again, so if we had our numbers to go by, total cholesterol less than 200. HDL, we went more than 40. LDL, we want less than 100. Triglycerides, we want less than 150. Everything else would be borderline, or greater than 200 is considered high. For triglycerides, greater than 160 is high. For LDL, 40 or less. And HDL is considered low, which is not good. We want the H-- we want the happy cholesterol. Total cholesterol, anything greater than to 40.

So as an FYI, look those over. Make sure patients understand those. When you look at the hypertension table, if you go to what I have put on this website here, what you'll be able to do is click on that link, and you'll be able to go to the 2014 JNC8 protocol for high blood pressure and how do you treat hypertension those type of things

Make sure that you are using again, the evidence-based practice. So you want to make sure that you're not just coming up with something that you've used in practice before, it appeared to work, so that's what you're going to stick with now. Patients are all different. They all change. And so you want to make sure that you've got a compliant patient as well.

Don't give them a water pill twice a day, a lot of times that doesn't help them. Start them off with exactly like the JNC8 says-- you can give them a diuretic, however, you can marry it ACE or an ARB. Just giving them a water pill doesn't always keep them compliant. So just kind of keep that in mind. And I don't want to say never, I don't want to say don't. I want you to follow the JNC8. I want you to follow those maps.

The other thing that I wanted to talk to you about, do not ever forget that psychological and physiological are one and the same. Those are married as well. So remember that if you're dealing with somebody that's new to the coronary artery disease, or cardiovascular impairment, or respiratory impairment situations, make sure that you're treating both physiological and psychological aspects of these patients.

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The other thing that we can talk about, going back to our topics here, we can actually look at deep vein thrombosis. When we talk about deep vein thrombosis, make sure that you're looking at the individual, asking them the appropriate questions. Are they having trouble with swelling? Is there a partial occlusion, which could be the greater saphenous vein-- popliteal, which is behind the knee-- lesser saphenous vein? The partiality, or occlusion by thrombosis, it is essential that you identify that on your diagnostics.

Complete occlusion is going to be completely occluding the artery. The other thing that you would look at is, obviously, the deep vein clots that are in the femorals. These blood clots can actually travel, break free, and travel back, and go into the pulmonary. Which therefore, you would have the pulmonary edema.

OK. We've talked about hypertension, so make sure you look at the JNC8. Study [AUDIO OUT]. OK. So make sure that you're looking at-- sorry about that delay. Make sure you're looking at the COPD, or the hypertension, DVTs, coag, lipids, valvular disorders, endo and myocardial infarction.

The other thing that you want to look at is the COPD, and how that's effective. And as well as the pneumonias, whether they're community acquired pathogens, the characteristics of such. How do you treat them? What is it you're looking at? End patient-- are they in intensive care, not in intensive care? What is it that you're dealing with? Always make sure you know the pathogen.

You also want to look at COPD as far as, if it is the alveolar membrane degraded? Is it the inflammation or excess mucus from the muscle constriction related to bronchitis? What is it that you're dealing with, with these individuals?

And then always makes sure-- the one thing that I always see, that is a problem in relation to COPD, is we're not treating them effectively. So we are using medication-inhaled corticosteroids. We're using systemic corticosteroids. But we're not using the short-acting steroids, so we're not giving them a total relief. We're giving them longterm, as far as indications to initiate that long-term, greater than 15 hours in a day. Sometimes they're on O2, sometimes not.

But our goal is to ensure adequate oxygen delivery to those vital organs. If we're cheating them out of any certain part of the day, then we're cheating the other organs out of their necessary nutrients to function appropriately. So remember-- SABA, LABA-go by the gold standards that you will find. There will be a link on the website for the gold standards. Make sure that you follow those pathways on treatment methodology, as well as on the asthma and your pneumonias.

OK. And this is the conclusion of week three. And if you have any questions, please don't hesitate to reach out to your instructor. Everyone have a wonderful week.

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