Clinical Models for Altered Perfusion.docx

Clinical Models for Altered Perfusion Hypertension (HTN) Pathophysiology • A progressive cardiovascular syndrome detected by an elevation in blood pressure and/or the presence of organ damage due to persistent blood pressure elevations • Primary versus secondary Risk factors: • Family history of hypertension • Excessive dietary sodium intake • Aging • Smoking • Diabetes mellitus • Excessive alcohol intake • Obesity • Sedentary lifestyle Clinical Manifestations • Often asymptomatic • Weakness • When advanced, causes CNS changes: • Confusion • Headache • Vomiting • Fatigue • Mental status changes • New-onset blurred vision • Nausea Diagnostic Criteria • History and physical examination • Serial blood pressure measurements • Laboratory studies • Classification: ◦ Prehypertension ◦ Stage 1 ◦ Stage 2 Treatment • Pharmacologic treatments • Lifestyle modifications ◦ Weight reduction ◦ Decreased alcohol, salt & saturated fat intake ◦ Increased aerobic physical activity ◦ Increased fruit and vegetable intake ◦ Smoking cessation Shock Pathophysiology • A condition of circulatory failure and impaired perfusion of vital organs • Sources of impaired perfusion: ◦ Cardiogenic Shock: Ineffective cardiac pumping ◦ Hypovolemic Shock: Decreased blood volume • Sources of impaired infusion (cont’d): ◦ Massive systematic vasodilation:  Septic Shock  Neurogenic Shock  Anaphylactic Shock  Compensatory mechanisms Clinical Manifestations • Tachycardia, tachypnea • Cool, clammy extremities with poor peripheral pulses • Decreased arterial blood pressure (a late sign indicative of decompensation) • Cyanosis and/or pallor • Restlessness, apprehension, decreased mental function • Poor urinary output Diagnostic Criteria • No one test is completely specific or sensitive for shock • History and physical examination • Laboratory studies • Diagnostic testing Treatment • Medical emergency: airway, breathing, circulation • Cardiogenic • Hypovolemic • Septic • Neurogenic • Anaphylactic Myocardial Infarction Pathophysiology • Total occlusion of one or more coronary arteries resulting in ischemia and death of myocardial tissues • Atherosclerosis is most common cause Major Risk Factors: • Family history of CAD • Hypertension and smoking • Blood cholesterol levels • Concurr