Medical Facts about Cerebrovascular Disease

The effects of cerebrovascular disease on your patient and his family can be devastating. A tremendous amount of education and support is needed for optimum recovery.

During the acute phase of a CVA, orient the patient and his family to the unit, to the procedures being performed and the equipment used, and to the treatment plan. Explain the need for rehabilitative therapy after the acute phase has passed.

Once the patient’s condition has stabilized and the amount of cerebral tissue damage has been determined, explain the disease, his deficits, and the planned rehabilitation. If necessary, ensure that each rehabilitation team member explains his or her specialty so that the patient and his family fully understand the rehabilitation process.

Teach the patient the signs and symptoms of a CVA and stress the importance of seeking treatment immediately if any of the following occur:

  • sudden onset of weakness, numbness, or paralysis of the face, arm, or leg, usually on one side of the body
  • sudden blurring or loss of vision in one or both eyes
  • loss of speech or trouble talking or understanding speech
  • sudden severe headache
  • unexplained dizziness or loss of balance, especially if combined with other signs and symptoms.

If the physician prescribes an antihypertensive, anticoagulation, or anti platelet aggregation drug, teach your patient the name of the drug, its dosage, and its therapeutic and adverse effects. If he must take an anticoagulant, also teach him the signs and symptoms of bleeding that he should report .

If the physician has prescribed warfarin, tell your patient which drugs interact with it. Instruct him to maintain a diet that provides moderate amounts of vitamin K. Explain that extreme variations in vitamin K intake can cause wide fluctuations in the anticoagulant level. Tell the patient to avoid trauma and to wear a medical alert tag or bracelet at all times. Inform him that he’ll need frequent blood tests for his physician to adjust the warfarin dose.

Depending on the amount of cerebral damage, your patient may be transferred to a rehabilitation facility or a skilled nursing facility for further treatment. If he requires a wheelchair or walker, tell him that a home care nurse or other health provider should visit his home to identify physical barriers that would limit their use.

Explain that the home care nurse will monitor his vital signs, check his compliance with antihypertensive drug therapy, and assess his response to the drug. She’ll evaluate his bowel and bladder function and provide retraining, if necessary. She’ll also assess his response to rehabilitation, determining which assistive devices might be useful to him.

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Hypertensive Encephalopathy and Nursing considerations

Monitor your patient’s neurologic status frequently. Look for signs and symptoms of worsening neurologic deficits, such as mental status changes, agitation, weakness, unequal pupils, vomiting, and bradycardia. Each time, compare your findings with those of your previous assessment and immediately report any changes to the physician.

If you’re administering mannitol, closely monitor your patient’s intake and output to assess fluid balance and fluid loss. Include the mannitol as part of his intake.

Monitor his cardiovascular status by taking continuous blood pressure readings using an arterial line or an automatic sphygmomanometer. Be alert for potential cardiac decompensation, such as ectopy or heart block.

Assess the rhythm and depth of the patient’s respirations, his respiratory rate, and any changes in his breathing pattern. Cheyne-Stokes respirations-episodes of apnea that last 10 to 60 seconds followed by a gradual increase in respiratory rate and depthmay result from brain stem herniation.

Closely monitor your patient’s serum electrolyte levels, including his potassium, sodium, and chloride levels. Also, check his BUN, creatinine, and arterial blood gas (ABG) levels and blood pH. Obtain a complete blood count, as well.

Treatment Plan

During the acute phase of your patient’s condition, orient him and his family to the unit. Explain the treatment plan, including the diagnostic tests that will be performed.

Before discharge, explain the need for strict compliance with the prescribed antihypertensive drug regimen. Stress the importance of reducing risk factors that can exacerbate his hypertension. Be sure to describe the underlying disorder that led to his severely high blood pressure and subsequent hypertensive encephalopathy.

If your patient will be discharged to his home, the home care nurse should evaluate his compliance with the drug regimen and recommended lifestyle changes. She should monitor his blood pressure and be alert for the recurrence of neurologic deficits, such as localized weakness, agitation, confusion, blurred vision, dizziness, and light­headedness.

A patient who has had hypertensive encephalopathy may need extensive rehabilitation. His home care nurse should oversee the rehabilitative therapies he’ll need, such as exercise and physical therapy. And she should reevaluate his plan of care regularly to determine whether it remains realistic and whether the goals are being met.

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Nursing Considerations of Beta-Blockers

Before you administer selective beta-blockers, measure your patient’s apical and radial pulses. When using a nonselective beta-blocker, obtain his baseline pulse rate and blood pressure before each administration. Also, if he has impaired renal function, anticipate a reduced dosage.

Administer atenolol by slow I.V. push, not to exceed 5 mg over 5 minutes, or dilute it in 10 to 50 ml of D5W, dextrose 5% in normal saline, or normal saline. To administer esmolol, begin with an I.V. bolus dose of 0.5 to 1.0 mg/kg followed by an infusion. Dilute it in D5W, Ringer’s solution, or sodium chloride, and administer it at a rate of 50 to 100 micron g/kg/minute with an infusion pump. Also, if your patient’s blood pressure is less than 100/60 mm Hg, notify the physician before giving esmolol.

Usually, oral forms of selective and nonselective beta-blockers can be given before meals and at bedtime, as prescribed. They can be taken with food to reduce GI upset. Also, the tablets can be crushed or swallowed whole.

However, the patient should take pindolol with or immediately after meals. If orthostatic hypotension is severe, he should take this drug at bed­time.

Administer nadolol with at least 8 ounces of water. Propranolol should also be administered with 8 ounces of water but on an empty stomach. And don’t give propranolol with aluminum-containing antacids because they decrease the drug’s absorption in the intestine.

When using either selective or nonselective beta-blockers, frequently measure your patient’s blood pressure for hypotension. Depending on his status, monitor his pulse rate, rhythm, and quality at least every 4 hours. Also, watch for signs of heart failure.

If your patient has diabetes, monitor his blood glucose levels. Also, monitor his fluid balance by measuring intake and output and by obtaining daily weights. Report any significant changes to his physician.

Check the patient’s skin turgor and mucous membranes for signs of dehydration, especially if he’s elderly. If he develops any CNS effects such as confusion, institute safety precautions.

Instruct your patient to take his drug exactly as prescribed. Also, tell him to avoid using OTC nasal decongestants or cold preparations because they contain alpha-adrenergic stimulants and can cause adverse reactions such as arrhythmias.

Teach the patient how to take his own blood pressure and pulse and tell him to notify his physician about abnormal findings. He should report difficulty breathing, night coughing, or swelling of the legs. Tell him to also report any complaints of dizziness, confusion, depression, and fever. If he’s experiencing dizziness, instruct him to avoid activities such as driving. And warn him against abruptly discontinuing his beta-blocker therapy because he may develop life-threatening adverse effects .

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Hypertension and Endocrine Disorders in Old Age Patients

Systolic hypertension is more common in elderly patients. Elevated systolic blood pressure readings are usually caused by increased CO, systemic vascular resistance, or both. The main vascular cause of systolic hypertension is rigidity of the aorta, which develops from arteriosclerosis and increases total peripheral vascular resistance. Normally, the elastic aorta stretches as blood is pumped from the heart, but with decreased elasticity and compliance, systolic pressure increases significantly.

Aging also causes hyaline degeneration of the tunica media of arterioles, reducing lumen size. Further, decreased baroreceptor sensitivity may contribute to increased sympathetic nervous system activity and elevated levels of norepinephrine.

About 45% of the elderly in the United States have systolic blood pressures of 160 mm Hg or higher and diastolic pressures of less than 90 mm Hg-a condition known as isolated systolic hypertension. Generally, this condition reflects a disease process resulting in lost elasticity of the aorta and its large branches. Other than advanced age, this condition is the greatest risk factor of endocrine disease in elderly patients.

Endocrine Disorders

Pheochromocytoma, an abnormal growth of new tissue on the adrenal medulla, produces excessive catecholamines, causing hypertension. These tumors occur most commonly in patients ages 40 to 60, and about 90% of them are benign.

A patient with pheochromocytoma may experience severe headaches, profuse sweating, palpitations, and pronounced pallor caused by a sudden release of catecholamines resulting in a hypertensive crisis. These attacks can be triggered by physical activity, postural changes, emotional distress, hypoglycemia, and surgical trauma. An attack may also be provoked when the tumor is palpated.

If left untreated, a patient with pheochromocytoma can develop diabetes, cardiomyopathy, and hypertension, any of which can result in death. The usual treatment is surgical removal of the tumor, which relieves hypertension in about 75% of patients. The remaining 25% can usually manage their hypertension with antihypertensive drug therapy.

Caused by excessive aldosterone secretion of the adrenal gland, primary hyperaldosteronism is another endocrine disorder that causes hypertension. This condition is more common in women ages 20 to 50. Suspect it in hypertensive patients who have hypokalemia and don’t take diuretics.

The three causes of primary hyperaldosteronism are unilateral adrenocortical adenoma, adenomatous hyperplasia, and adrenocortical carcinoma. Unilateral adrenocortical adenoma alone causes 80% to 85% of the cases of primary hyperaldosteronism.

Physicians typically treat primary hyperaldosteronism by surgically removing the tumor. Unfortunately, surgery generally doesn’t cure hypertension resulting from adenomatous hyperplasia.

Cushing’s syndrome, another cause of hypertension, results from either prolonged treatment with large doses of glucocorticoids or excess cortisol production by the adrenal cortex, which is most commonly caused by a pituitary tumor. In either case, hypertension results from the mineralocorticoid effects of the hyperfunctioning adrenal tissue. When a pituitary tumor causes Cushing’s syndrome, the usual treatment consists of surgical removal. Hypertension can also be caused by acromegaly-a chronic metabolic condition resulting from excessive production of growth hormone in the anterior pituitary. The condition is characterized by enlargement and elongation of the bones of the face, jaw, and extremities. Although one­third of patients with acromegaly have hypertension, it’s usually not severe, and the treatment of acromegaly-surgery, radiation, and drugs-usually alleviates the hypertension.

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Fasting Lipid Profile to Measure Cholesterol

The fasting serum lipid profile measures total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol levels. This test helps in the overall assessment of hypertension and in identifying a patient’s risk of developing coronary artery disease (CAD).

Hyperlipidemia commonly results from hyper­tension. Hypertension injures the endotheliallining of the arterial wall. And this damage promotes platelet aggregation and lipid deposits, leading to intracoronary atherosclerosis and plaque formation.

Patient preparation

To obtain accurate test results, tell the patient to fast for 14 hours before the test. He may drink water during the fast, but he should abstain from drinking alcoholic beverages before the test. Also, he should avoid exercising immediately before the test.

The patient should maintain a stable diet and lifestyle for 2 weeks before this test. An acute illness or an exacerbation of a chronic illness can cause inaccurate test results. Also, certain drugs­such as antilipemics, oral contraceptives, corticosteroids, and diuretics-can interfere with the test results.

Test Implications

High levels of total cholesterol and LDL cholesterol can indicate the development of CAD, as can low levels of HDL cholesterol. A patient’s risk of CAD also increases when elevated triglyceride levels appear in conjunction with high LDL and low HDL cholesterol levels.

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Mens Health can be improved by supplements

Mens healthrent a car bulgaria is one thing that is a major issue of concern these days. It is so because men tend to work for comparatively longer durations of time and are involved in tougher jobs. So, they often ignore their health and thus weaken their bodily functions. In such conditions it becomes really important that they take ample care of their health and do not neglect the dietary needs of their body.

Usually men are unable to carry forward a balanced diet as they do not get enough time to maintain the dietary recommendations. So, they lose tremendously on their health chart; complain of insomnia and constant fatigue along with the experience of low energy levels. To combat this very problem that pertains to men’s health, there are various health supplements that are available in the market now. These health supplements can also be availed online very easily.

On the consumption of these supplements, men’s health can be easily taken care of as they contain adequate amounts of minerals and vitamins. Some of them also have great anti oxidant properties, fatty acids, meal replacements and energy bars that aid in improving the health of men. As the men today are also conscious about their looks, various supplements that can cater to the enhancing of their skin color and texture can also be availed.

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Hypertension Prescription Drugs

Many drugs for hypertension can increase blood pressure or interfere with other drugs used to treat hypertension. Oral contraceptives, for example, cause a small increase in systolic and diastolic blood pressure. Hypertension is two to three times more common in patients who use oral contraceptives for more than 5 years than in patients who haven’t used them at all. A patient who uses oral contraceptives has an increased risk of developing hypertension, with increasing age, duration of use, and body weight.

Estrogen, when used as a postmenopausal replacement therapy, increases blood pressure in some women. All women receiving hormone replacement therapy should have their blood pressure routinely monitored.

Cyclosporine, which is used as an immunosuppressant to prevent organ rejection in transplant recipients, causes vasoconstriction and reduces renal blood flow. Cyclosporine also increases the reabsorption of sodium, water, and urea and has a direct toxic effect on the nephrons. Vasoconstriction and sodium retention lead to hypertension in 50% to 70% of organ transplant recipients taking cyclosporine and in about 20% of nontransplant patients taking the drug for other reasons. Similarly, corticosteroids used to produce immunosuppression in organ transplant recipients can cause hypertension.

Monoamine oxidase (MAO) inhibitors, which are used for treating depression, can cause a severe hypertensive crisis. This condition results from an interaction of the MAO inhibitors with foods such as cheese, bananas, beer, wine, yeast, yogurt, and meat extracts containing tyramine, dopa, or serotonin. Patients who use MAO inhibitors should have their blood pressure monitored regularly.

Erythropoietin-a hormone that acts on bone marrow cells to stimulate red blood cell (RBC) production-causes increased blood pressure in one-third of patients with end-stage renal disease. Although the exact mechanism of action is unknown, erythropoietin may increase systemic vascular resistance by increasing blood viscosity and reversing hypoxic vasodilation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase blood pressure by blocking the production of prostaglandins in the kidneys, which leads to sodium and water retention. These drugs also antagonize the effects of some antihypertensive drugs, such as diuretics, by blocking sodium excretion. And NSAIDs cause vasoconstriction by affecting the renin-angiotensin-aldosterone system. African-Americans, diabetic patients, and the elderly are most vulnerable to the effects of NSAIDs. Keep in mind that the elderly commonly use NSAIDs for arthritis.

Cold remedies, nasal decongestants, and appetite suppressants also can cause hypertension. Generally, cold remedies and nasal decongestants are powerful vasoconstrictors that increase systolic and diastolic blood pressures. Appetite suppressants such as amphetamines, however, increase blood pressure by stimulating the CNS. Other types of appetite suppressants, such as dexfenfluramine, can cause primary pulmonary hypertension without affecting systemic blood pressure. Patients with advanced atherosclerosis, cardiovascular disease, or moderate to severe hypertension shouldn’t take appetite suppressants.

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Herbal Treatment of Depression

Depression is a mental abnormality in which the patient feels sad and worry. The mental manifestations are because of the chemical disturbances in the brain which enables the brain cells to communicate with each other. The various forms of treatment are recommended for depression depending upon the seriousness of depression. If the depression is mild then Psychotherapy is suggested In this treatment only a proper counseling is provided to the patients. It generally requires eight to twelve sitting with the patient. The other way of treating the patient is with the help of the medicines. There are two subcategories in the medicinal treatment. The first category involves the allopathic medicine treatment. The main medicines suggested in these categories are of Benzodiazepines and SSRI class. But these medicines have sever side effects because these drugs can either cause other physical disorders in the patient or the patient can get addicted of these drugs. So another class of medicines called Herbal remedy is selected. This medicines have gained so much popularity in recent years because these have no side effects. St. Johns Wort Extract helps to change the mood of patient in a positive manner. The results of these drugs are very fast. This drug can be taken in the form of tea, oil and capsules. The sunlight can destroy the effects of these drugs. So these must be kept at a cool and dark place, The other natural herbal supplements are ginseng and Kava Kava. The herbal supplements helps in increasing the power of immune system so the body can fight with diseases like depression in an efficient manner. Vitamin B12, B6, Calcium Citrate, Omega three fatty acids are helpful in providing control in mental abnormalities. So these can be taken in the form of a herb for depression and Anxiety relief.

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Complications of Untreated Hypertension

Hypertension is sometimes called the “silent killer” because many people don’t know they have it. If left untreated, chronic systolic and diastolic hypertension damages the walls of systemic blood vessels and organs such as the heart, brain, kidneys, and retina. Eventually, this organ damage can result in coronary artery disease (CAD), CVA, renal failure, and blindness .

Coronary Artery Disease

Hypertension is the main risk factor for developing CAD from atherosclerosis. With hypertension, atherosclerotic plaque forms in the inner lining of the artery at an accelerated rate. As the artery narrows, more force is needed to pump blood through it, creating an even further elevation in blood pressure.

Cerebrovascular Accident

Hypertension is also a serious risk factor of CVA. In fact, hypertension is a leading cause of transient ischemic attacks and CVAs resulting from cerebral thrombosis, intracerebral hemorrhage, and emboli.

Cerebral arterial hemorrhage can occur when progressive atherosclerotic changes take place and blood pressure increases in the affected vessels. Eventually, smooth blood vessel tissue is replaced with fibrous tissue, causing vessel walls to become thicker and more rigid. But the vessels also weaken because of intense constriction of the cerebral arterioles and arteries, resulting in the development of microaneurysms that tend to rupture easily.

Renal Disease

Hypertension also leads to end-stage renal disease. During the early stage of hypertension, the capillary basement membrane of the glomeruli becomes thickened by atherosclerosis. Hypertension then causes a gradual destruction of the glomeruli, tubules, and nephrons. At first, a patient’s glomerular filtration rate may remain normal, but scarring eventually occurs, causing renal failure. Although most hypertensive patients have some degree of renal dysfunction, African-American hypertensive patients have the greatest risk of developing end-stage renal disease.

Retinopathy

Hypertension can also cause retinopathy. The resulting retinal changes are categorized in four stages of increasingly severe vessel damage.

Usually, the early stages go undetected because the patient has no significant signs or symptoms to report and no apparent reason to seek medical attention. However, if his hypertension is left untreated and his condition progresses into the later stages of retinopathy, he may develop retinal lesions, which can cause blurred vision, or papilledema and retinal hemorrhaging, which can result in blindness.

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Nueslim: a safer alternative to harsh weight loss regimes!

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These are the wise people who opt for Nueslim diet pills those have got a reputation of the best diet pills in the market today. This does not mean they are out of reach for common man. They are very much affordable even for online transactions and can reach your doorstep with your instructions.

One always wishes to have that dream figure that turns eyes. Now with Nueslim diet pills it is no more just a dream but a soon would be reality. Be regular in your consumption of pills and you will start visualizing their effect from first week itself. And that too without strenuous exercise and diet. Why to go for harsher weight loss regimes when such a safe and effective treatment is available at your doorstep? Be net friendly and order your Nueslim diet pills today! Don’t delay!

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