Michael Emory

            MTCC PNE / NUR 101

                                                 Chronic Kidney Disease (CKD)                    

Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The early symptoms of worsening kidney function vary and often go un-noticed. Chronic kidney disease (CKD) causes destruction of the kidneys. It is progressive and irreversible. (Brunner).

Your kidneys are an essential part of your body’s ability to function. They have a number of functions: they help maintain the balance of minerals and electrolytes such as calcium, sodium, and potassium, they play an essential role in the production of red blood cells, they maintain the delicate acid-base balance of the blood, and they excrete water soluble wastes from the body. Each kidney contains about one million tiny filtering units called nephrons. (Shier, 12th Edition) Any disease that injures or scars these filtering units can cause kidney disease. (White etal., 2011)

Diabetes and high blood pressure can both damage the nephrons. (Brunner) High blood pressure can also damage the blood vessels of the kidneys, heart, and brain. This is key, because, in general, blood vessel diseases are dangerous to the kidneys. The kidneys are vascular—meaning they contain lots of blood vessels. (Brunner) The risk of CKD increases over the age of 65 and chances seem to increase if there is a family history of renal disease. It is more likely to occur in African-Americans, American Indians, and Asian Americans. Other risk factors for CKD include: cigarette smoking, obesity, high cholesterol, diabetes, and autoimmune disease. (White etal., 2011)

CKD does not cause noticeable symptoms until about 90 percent of the kidney has been destroyed. Once the kidney is severely damaged, symptoms of CKD could include: swelling around the eyes (per orbital edema), swelling of the legs (pedal edema], fatigue, shortness of breath, nausea vomiting, especially in the morning and after eating. (Brunner). BUN can be elevated when the kidney starts to fail. Normally, the kidney clears products of protein breakdown from the blood. However, after kidney damage,

byproducts build up. Urea is one byproduct of protein breakdown. Urea is what gives urine its odor. (Brunner).

The diagnosis of CKD begins with a medical history. A family history of kidney failure can raise suspicions. So can a history of high blood pressure or diabetes. However, other tests are needed to confirm a CKD diagnosis.  A complete blood count (CBC) can show anemia. Kidneys produce erythropoietin. This is the hormone that stimulates the bone marrow to produce red blood cells. When the kidney is severely damaged, the ability to produce erythropoietin decreases. This causes the decline in red blood cells known as anemia. (Brunner).

Procedures that can be done to help with the diagnosis include a Renal Flow and Scan.  This is an imaging study of kidney function A Renal Ultrasound This noninvasive test measures the kidneys and prostate. It gives information about whether an obstruction is present.  Additional tests for CKD include: biopsy of the kidney, bone density test, abdominal computed tomography (CT) scan abdominal magnetic resonance imaging (MRI).  (Brunner).

CKD is chronic and irreversible. Treatment focuses on improving the underlying disease.

Treatment can also prevent and manage complications of CKD, such as: fluid overload, congestive heart failure, anemia, and weight loss and electrolyte imbalance. Control of underlying problems, such as hypertension and diabetes, can slow the rate of kidney damage. Chronic kidney disease frequently progresses to complete kidney failure. When this happens either dialysis or a kidney transplant is necessary for continued survival.  There are steps a person can take to properly manage chronic kidney disease and prevent the process from progressing.   One very important issue is controlling blood sugar. And keeping your blood pressure well controlled is probably two of the single best ways to manage chronic kidney disease So, Making exercise and healthy eating will help to regulate blood pressure and blood sugar which in turn helps to manage chronic kidney disease. (Brunner) (White etal., 2011) (Shier, 12th Edition)

                                                            

References

Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (7th ed.). Philadelphia, New York: Lippincott Williams & Wilkins.

 "Hole's Human Anatomy & Physiology (Shier), 12th Edition." Your Page Title. N.p., n.d. Web. 14 Nov. 2013. .

White, Lois, Gena Duncan, and Wendy Baumle. Foundations of Nursing. Clifton Park, NY: Delmar/ Cengage Learning, 2

Atrial Fibrillation (Afib)

Michael Emory

MTCC PNE

                                                 Atrial Fibrillation (Afib)  

Atrial Fibrillation (Afib)   is an irregular and often rapid heart rhythm.  The irregular rhythm, or arrhythmia, results from abnormal electrical impulses in the upper chambers (atria/atrium) of the heart that causes the heartbeat (ventricle contraction) to be irregular and usually fast.  The irregularity can be continuous, or it can come and go.  Some individuals, especially patients on medication, may have atrial fibrillation constantly but not have rapid (> 100 heartbeats per minute) at rest.  Normal heart contractions begin as an electrical impulse in the right atrium.  The impulse comes from an area of the atrium called sinoatrial (SA) or sinus node, the “natural pacemaker” that causes the normal range of regular heartbeats.  In an adult person with a normal heart rate and rhythm the heart beats 50-100 times per minute at rest.  If more than 100 time per minute, the heart rate is considered fast (tachycardia).  If the heart beats less than 50 times per minute, the heart is considered slow (bradycardia).

In atrial fibrillation, multiple sources of impulses other than only from the SA node travel through the atria at the same time.  Instead of coordinated contraction, the atrial contractions are irregular, disorganized, chaotic, and very rapid.  The atria may contract at a rate of 400-500 beats per minute.  The blood flow from the atria to the ventricles is often disrupted.  These irregular impulses reach the AV node in rapid succession, but not all of them make it past the AV node.  Therefore, the ventricles beat more slowly than the atria, often at fairly fast rated of 150-180 beats per minute in an irregular rhythm.  The resulting rapid, irregular heartbeat causes an irregular pulse and sometimes a sensation of fluttering in the chest.

Atrial fibrillation can occur in several different patterns:

Intermittent - The heart develops atrial fibrillation and typically converts back again spontaneously to normal (sinus) rhythm.  The episodes may last anywhere from seconds to days.

Persistent - Atrial Fibrillation occurs in episodes, but the arrhythmia does not convert back to sinus rhythm spontaneously.  Medical treatment or cardioversion (electrical treatment) is required to end an episode.

Permanent - The heart is always in atrial fibrillation.  Conversion back to sinus rhythm either is not possible or is deemed not appropriate for medical reasons.  In most cases, the rate is reduced by medications and the patients are placed on anticlotting medications for their lifetime.

Atrial Fibrillation or A Fib is one of the most common heart rhythm disorders.  It affects about 4% of the population, mostly people older than 60 years.  This amounts to more than 2.6 million people in the U.S.  People older than 40 have about a 25% chance of developing Afib in their lifetime.  The risk of developing A fib increases as we get older.  About 10% of people older than 80 years have atrial fibrillation.  For many people, A fib may cause symptoms but does no harm.

  Complications like blood clot formation, strokes and heart failure can arise, but appropriate treatment reduces the chances that such complications will develop.

 Some of the signs and symptoms that may be seen are shortness of breath, wheezing, chest tightness and edema in lower extremities.  Due to the possibility of edema and fluid retention of the patient the Dr. may perform a thoracentesis to remove fluid from the pleural space within the

chest wall. Latter a chest X ray may be ordered to check for fluid within the lower lobes of the lungs.  An EKG will show there is a rapid atrial flutter, along with Para pneumonia effusion.

Following these tests patients can be started on several different drugs:

1.  Digoxin (Lonoxin):   This drug decreases the conductivity of electrical impulses through the AV node.  Digoxin is currently used primarily in patients with associated heart disease, such as poorly functioning left ventricle.  The health care provider, nurses, and AP staff should monitor patient for edema and wheezing.

2.  Coumadin (Warfarin):  A blood anticoagulant that inhibits the function of Vitamin K dependent coagulation.  Coumadin is used to inhibit the coagulation of blood to reduce or prevent the chance of developing heart attacks, strokes and venous and other blood clots; deep vein thrombosis, pulmonary embolisms and thrombi produced by atrial fibrillation.  The most common side effect of this drug is bruising and bleeding.

3.  Lasix (Furosemide):  This drug belongs to a group of medications called loop diuretics (water pills).  Lasix is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease and other medical conditions. Together with other medications it can be used to treat high blood pressure.  If this drug is used for a long time, the heart and arteries may not function properly.  This can damage many vital organs resulting in stroke, heart failure, or kidney failure.

Works Cited:

Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.

COPD

Michael Emory

NUR101/ MTCC PNE 2014

                                              COPD

     Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus, and Emphysema, which leads to the destruction of the lungs over time. Most people with COPD have a combination of both conditions.

     Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. (Hanania). Other risk factors for COPD are; Exposure to certain gases or fumes in the workplace, Exposure to heavy amounts of secondhand smoke, pollution, and frequent use of cooking fire without proper ventilation. (Hanania).

     The most common symptoms are cough, with or without mucus, fatigue, respiratory infection, shortness of breath that gets worse with mild activity, trouble catching one's breath and wheezing. Because the symptoms of COPD develop slowly, some people may not know that they are sick.

     The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to radiation. (Hanania) Using a stethoscope to listen to the lungs can also be helpful. However, sometimes the lungs sound normal even when COPD is present. Pictures of the lungs (such as x-rays and CT scans) can be helpful, but they also sometimes look normal even when a person has COPD. Sometimes patients need to have a blood test to measure the amounts of oxygen and carbon dioxide in the blood to determine if there is adequate gas exchange. (Hanna).

     There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse. Persons with COPD must stop smoking. This is the best way to slow down the lung damage.

     Medications used to treat COPD include: Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol, Inhaled steroids to reduce lung inflammation, Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used. (Hanania) In severe cases or during flare-ups, you may need to receive: Steroids by mouth or through a vein (intravenously), Bronchodilators through a nebulizer, Oxygen therapy assistance during breathing from a machine, using a mask, BiPAP, or endotracheal tube. (Hanania) Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse.(Hanania) You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help maintain muscle strength in the legs. Walk to build up strength and slowly increase how far you walk. Try not to talk when you walk if you get short of breath. Use pursed lip breathing when breathing out to empty your lungs before the next breath.

     Things you can do to make it easier for yourself around the home include: Avoiding very cold air, Making sure no one smokes in your home, Reducing air pollution by getting rid of fireplace smoke and other irritants. Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories. People often can help ease the stress of illness so perhaps joining a support group in which members share common experiences and problems might be helpful.

     Surgery may be used, but only a few patients benefit from these surgical treatments. Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema and lung transplant for severe cases.

     COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with their doctor about breathing machines and end-of-life care.

References

Nicola A. Hanania, COPD (2011). Retrieved from http://Googleebook.com

Pulmonary Hypertension

                                                    Pulmonary Hypertension

Pulmonary hypertension (or PHT) is a type of heart disease that causes dangerously high blood pressure in your lungs, affecting the arteries of your lungs and part of your heart. It is a different measurement altogether from systemic blood pressure. It reflects the pressure the heart must exert to pump blood from the heart through the arteries of the lungs. Pulmonary blood pressure is normally a lot lower than systemic blood pressure. Normal pulmonary-artery pressure is about 14 mm Hg at rest. If the pressure in the pulmonary artery is greater than 25 mm Hg at rest and 30 mm Hg during exercise, it is abnormally high and is called pulmonary hypertension. (Web. O7 Nov. 2013). Symptoms of pulmonary hypertension may not develop until the disease has advanced, and if not treated, you may develop life-threatening diagnosis. Pulmonary hypertension can be diagnosed by a cardiologist or a pulmonologist with an echocardiogram, which uses sound waves to make a picture of your heart. (White & Duncan 2011).

Early on, you may think you're simply "out of shape" because general fatigue and tiredness are often the first symptoms. Symptoms are shortness of breath while exercising, and eventually, chest pain, fatigue, fainting, swelling in your feet, ankles and legs, and cyanosis of your lips, fingers and toes. (Web. O7 Nov. 2013)

Pulmonary hypertension is caused by the hardening or narrowing of the arteries in your lungs and the right side of your heart. Spending time at high altitudes (8,000 feet and higher) may cause you to develop pulmonary hypertension because of low blood oxygen or accumulation of fluid in your lungs. (Holes 2013)

Factors that increase your risk of pulmonary hypertension include older age, being female and having a family history of the condition. Medical conditions such as AIDS, chronic hepatitis, sickle cell anemia, sleep apnea, lupus and emphysema may cause you to develop secondary pulmonary hypertension. Complications of pulmonary hypertension may be fatal without treatment and include heart arrhythmia, bleeding into the lungs, blood clots and heart failure. (Web. O7 Nov. 2013)

The effects of Pulmonary Arterial Hypertension (PAH) are nonspecific; therefore persons with pulmonary heart disease may be required to undergo many different kinds’ lifestyle changes. If you smoke, stop. If you don't exercise, start. Excessive use of alcohol is not recommended, but some doctors may suggest a small glass of red wine every day, which may produce benefits from its high content of flavonoids and antioxidants. Flavonoids and antioxidants can also be found in foods from a well-balanced diet, including vitamin and mineral supplements. (Patient Survival Guide, Web. 07 Nov. 2013)

Exercise may help strengthen the heart muscle and help increase stamina and strength for some. Preventing further heart damage is the key to living with pulmonary heart disease. Controlling blood pressure and watching cholesterol levels are also important for anyone suffering from any form of heart disease. . (Patient Survival Guide, Web. 07 Nov. 2013)

Works Cited:

1) "Hole's Human Anatomy & Physiology (Shier), 12th Edition." Your Page Title. N.p., n.d. Web. 07 Nov. 2013. .

 2) "PULMONARY HYPERTENSION: A PATIENT’S SURVIVAL GUIDE." PH Patients Survival Guide. N.p., n.d. Web. 07 Nov. 2013. .

 3) "What Is Pulmonary Hypertension?" What Is Pulmonary Hypertension? N.p., n.d. Web. 07 Nov. 2013. .

4) Foundations of Nursing, White & Duncan, 3^rd Edition. 2011.