Cardiac/Vascular Nurse Exam Secrets Study Guide (18 page)

Prevention of renal vein thrombosis is difficult, as it is a rare condition. However, adults can avoid trauma to the abdomen or back, make sure they are properly hydrated and maintain good lifestyle habits.

Infants, toddlers and adolescents with the flu, out in very hot weather or exposed to other factors that can cause severe dehydration, should take preventative measures to avoid dehydration and potential for renal vein thrombosis.

General preventive measures that individuals can take to reduce the risk of renal vein thrombosis 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.

Treatment and prevention of atheroembolic renal disease

Treatment of atheroembolic renal disease is similar to atherosclerotic treatment. Pharmacologic agents used for the treatment of the disease include cholesterol medications such as statins; antiplatelet medications such as aspirin, ticlopidine, and clopidogrel; anticoagulants such as heparin and warfarin; antihypertensive agents such as ACE inhibitors, beta-blockers, or calcium channel blockers; and other classes of agents for concomitant or predisposing conditions such as diabetes. Patients at high risk for atherosclerosis may also be treated prophylactically with low dose aspirin and/or statins.

Lifestyle modifications are also recommended, which include maintaining proper lipid levels, blood pressure, glucose levels, 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. Lifestyle modifications can help prevent the progression of disease and initial onset of atheroembolic renal disease and/or atherosclerosis. However, pharmacologic management has not been demonstrated to improve patient outcomes or prevent onset of disease.

General preventive measures that individuals can take to reduce the risk of atheroembolic renal disease and disease complications include maintaining proper lipid levels, blood pressure, glucose levels, 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.

Treatment and prevention of Marfan syndrome

There are no treatments currently available to treat Marfan syndrome directly. However, practicing clinicians can address complications of the condition such as cardiovascular, skeletal, and eye complications.

Pharmacologic agents used to treat Marfan syndrome with cardiovascular complications include antihypertensive agents such as beta-blockers, calcium channel blocker, angiotensin-converting enzyme inhibitors, or angiotensin receptor inhibitors. Surgical approaches include aorta composite graft repair or an aortic valve sparing technique. The extent of surgery depends on how much of the aorta is involved.

For skeletal complications, a back brace may be used to treat scoliosis. Other options for scoliosis include surgery to correct the curvature of the spine as well as posterior spinal fusion. Surgery may also be an option for children with a concave chest that affects their breathing capabilities.

For eye complications such as dislocated lens, patients may wear glasses or undergo intraocular lens implant surgery. Glaucoma is not curable but can be treated with eye drops, oral agents, and surgical approaches. Patients with cataracts can undergo surgery to correct the problem.

Pharmacologic agents used for the treatment of Marfan syndrome include beta-adrenergic inhibiting agents such as atenolol and calcium channel blockers such as verapamil hydrochloride. Other antihypertensive agents may be used in combination or as second-line therapy in patients who either fail first-line approaches or who cannot tolerate adverse events. Other pharmacologic approaches can be used to treat other complications of the condition including agents directed toward the skeletal system and other cardiovascular agents. However, pharmacologic agents will not cure the Marfan syndrome but will treat the complications of the syndrome. Yet, progression of complications may continue even with pharmacologic management. Therefore, lifestyle modifications and surgery may be other options.

Pregnancy is not recommended for women with Marfan syndrome due to risk of aortic dissection and rupture. Also, women can pass the disease to their offspring; therefore, not having children is the only way to prevent passing the disease onto offspring.

General preventive measures that individuals can take to reduce the risk of Marfan syndrome and disease complications include maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use. Physical activity is recommended based on the type of organ systems affected by Marfan syndrome.

Treatment and prevention of atrial septal defect

In patients with atrial septal defects with few or no symptoms, treatment may not be required, especially in patients with a small defect. However, in patients with larger defects, surgical closure is recommended. Devices such as the Amplatzer device may be used to close the defect using catheterization. Minimally invasive surgical approaches may be used to prevent use of blood or blood products in certain patients.

In some cases, especially in very young patients or elderly patients, prophylactic antibiotics may be administered prior to surgery to prevent onset of infective endocarditis post surgery. Also, postsurgical care to prevent onset of infective endocarditis may also be recommended. Pharmacologic management does not fix the defect, but can be used to alleviate some of the symptoms associated with the condition. Pharmacologic agents that may be recommended include beta-blockers such as metoprolol, propranolol, and digoxin, diuretics such as furosemide, and anticoagulants such as warfarin, and antiplatelet agents such as aspirin.

Since atrial septal defects are inherited, they cannot be prevented. However, addressing the defect earlier on in the progression of the condition may prevent complications associated with the condition. Yet, the only way to prevent potential transmission of atrial septal defects is not to have children. However, in some cases, the disease arises from new genetic mutations during pregnancy.

Treatment and prevention of pulmonary embolism

Treatment of pulmonary embolism involves lifestyle modifications, pharmacologic management and, in more severe cases, surgery. Immediate treatment with anticoagulation therapy is necessary for patients with suspected pulmonary embolism, as treatment decreases mortality risk.

Fibrinolytic therapy is recommended for patients who are hemodynamically unstable, right heart strain, exhausted cardiopulmonary reserves, and those at risk for pulmonary embolism reoccurrence. Long-term anticoagulation therapy is considered for patients diagnosed with pulmonary embolism to prevent reoccurrence.

Pharmacologic agents used for pulmonary embolism include fibrinolytics such as reteplase, alteplase, and urokinase and anticoagulants such as enoxaparin, tinzaparin, unfractionated heparin, and warfarin.

Pulmonary embolism may occur postsurgically or as a result of other cardiovascular conditions. Therefore, hospitals take a prophylactic approach to prevent pulmonary embolism. Preventative strategies include heparin or warfarin therapy, use of graduated compression stockings, use of pneumatic compression, and increased physical activity.

Preventative measures individuals at high risk can take while traveling include increasing physical activity, exercising while seated by flexing and extending legs, using compression stockings, staying well hydrated, and using anticoagulants for long trips.

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

Treatment and prevention of deep venous thrombosis

The goals of treatment of deep venous thrombosis are to prevent pulmonary embolism and other complications associated with the condition. Treatment also aims to prevent the reoccurrence of formation of additional blood clots. Treatment involves lifestyle management, pharmacologic therapy, and, in more severe cases, surgical approaches. Pharmacologic management involves the use of anticoagulation therapy such as warfarin and/or heparin. Other pharmacologic approaches include antithrombotic agents and thrombolytics. Additional types of treatment include vena cava filter and graduated compression stockings.

Pharmacologic agents for deep venous thrombosis include anticoagulation therapy such as fondaparinux sodium, dalteparin, warfarin, enoxaparin, and tinzaparin and thrombolytics such as tenecteplase, urokinase, streptokinase, and alteplase.

Preventative strategies for deep venous thrombosis and risk of pulmonary embolism include heparin or warfarin therapy, use of graduated compression stockings, use of pneumatic compression, and increased physical activity.

Preventative measures individuals at high risk can take while traveling include increasing physical activity, exercising while seated by flexing and extending legs, using compression stockings, staying well hydrated, and using anticoagulants for long trips.

Treatment and prevention of venous insufficiency

The goal of treatment of venous insufficiency is to alleviate symptoms and address the underlying cause of the condition.

Treatment of venous insufficiency involves lifestyle modifications, pharmacologic management and, in some very severe cases, surgery. However, lifestyle modifications including bed rest to reduce leg swelling, avoiding prolonged periods of standing or sitting as well as the use of graduated compression stockings are the most common and effective approaches. Other more invasive approaches include valvuloplasty, radiofrequency ablation, vein stripping with ligation, sclerotherapy, skin grafting, and endovenous laser therapy.

Pharmacologic agents used to treat venous insufficiency include sclerosing agents such as sodium tetradecyl sulfate, antibiotics for infection and corticosteroids for associated inflammation.

Mild skin infections can be treated with antibiotics and/or steroids. Skin ulcerations can be treated with ointments, antibiotics, steroids and, in more severe cases, surgery.

Individuals with a family history of venous insufficiency should discuss prevention options with their practicing clinician. Also, individuals who are on their feet for long periods of the day with other cardiovascular comorbid conditions should consider the use of compression stockings.

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

Treatment and prevention of valvular disease

Lifestyle modifications, pharmacologic management, and surgery are approaches used to treat valvular disease. The goal of treatment is to reverse the underlying cause of the disease and/or alleviate symptoms in more mild cases. Treatment of valvular disease depends on the degree and extent of disease as well as the presence of other comorbid condition and the individual’s overall health.

Pharmacologic treatment does not cure the condition, but does relieve the symptoms of the disease and prevent further complications. Pharmacologic approaches used for valvular disease include vasodilators such as ACE inhibitors, antiarrhythmic agents, antibiotics, anticoagulants such as Coumadin, diuretics such as furosemide and hydrochlorothiazide, and inotrope.

Surgical approaches include percutaneous balloon valvuloplasty, valvulotomy, cardiac valve repair or replacement and minimally invasive heart surgery.

Congenital defects and infections such as rheumatic fever are the most common causes of valvular disease. Therefore, prompt treatment of streptococcal throat infections is necessary to prevent rheumatic fever. Also, addressing cardiovascular comorbid conditions and receiving proper treatment post myocardial infarction may prevent the onset of valvular disease. Also, proper treatment of connective tissue disease is important as is avoiding risk factors for endocarditis like IV drug use.

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

Treatment and prevention of angina pectoris

Treatment of angina pectoris involves lifestyle modifications, pharmacologic management, and surgery depending on the underlying causes of the condition. The type of treatment used depends on the extent and degree of the underlying cause of angina pectoris.