NURS5042 Tut 3

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The University of Sydney *

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5042

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Medicine

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Apr 3, 2024

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docx

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NURS5042: The Body, Its Function and Pharmacology School of Medical Sciences Tutorial 3 Cardiovascular complication Devised by: Dr Kyungjoon (Joon) Lim & Dr Elizabeth Cayanan Things to keep in mind during tutorials  What has been altered from normal physiology (e.g. what is not working)  Why is it not working (eg pathogenesis of the condition)  What does the patient look like? (clinical manifestations)- and does this change over the time course of the condition (eg early to late stage changes per clinical condition of relevance.  How should we manage the patient (as a nurse) ? After completing this workshop, you should be able to: - Extend from lecture - L02 explain pathogenic processes within the human body and their expression as observable alterations to normal anatomy/ physiological function across the life span - L03 synthesise, integrate and apply foundational human bioscience knowledge to specific contexts and situations in health - Extend from lecture - L04 locate and critically evaluate evidence-based drug information with respect to quality and relevance for informing decision making in nursing practice - Apply from lecture - L05 apply and integrate evidence-based pharmacotherapy knowledge to complex patients in order to optimise the quality use of medicines - L07 adopt an ethical, social and professional ethos in relation to the use of pharmacological therapies in health

After completing this workshop, you should be able to: - Have a firm understanding the following learning objectives related to Coronary Heart Disease, Hypertension and Myocardial Infarction. Coronary Heart Disease 1. Discuss the causes of coronary heart disease. 2. Discuss the pathogenesis of each of the following: 1. endothelial dysfunction 2. atherosclerosis 3. Heart Failure 3. Describe the pathogenesis and consequences of chronic ischaemic heart disease. 4. Discuss some of the factors which lead to cardiovascular disease. B. Hypertension and Myocardial infarction 1. Understand the classification(s) of hypertension. 2. Understand the meanings of primary, secondary, benign and malignant (accelerated) hypertension. 3. Discuss how and why hypertension causes pathological complications. 4. Describe the clinical effects that may occur following an acute myocardial infarction Extra resource: Utah Pathology Web Site Cardiovascular Disease: http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html Images 1-41 only

Tutorial Activities Case 1: Hypertension Link to case study A 66-year-old woman was hospitalized for intense dyspnoea . She had a history of arterial hypertension and diabetes mellitus since the age of 56. Upon examination, she was in her regular general state, cyanotic , with a respiratory rate of 40 rpm, heart rate of 110 bpm and blood pressure of 140/100 mmHg and had oedema in lower limbs and lungs. She had a cardiac arrest and died. Autopsy revealed severe left ventricular hypertrophy. There was no evidence of coronary artery thrombosis or myocardial infarction . 1. What is the difference between benign/essential hypertension and malignant/severe hypertension? Primary Hypertension Secondary Hypertension Abnormally high blood pressure that's not caused by a medical condition. E.g. Obesity High blood pressure that's caused by another medical condition. E.g. Diabetes Malignant Hypertension (hypertensive crisis) Benign Hypertension (Hypertensive stage 1/2) Acute, severe and sudden onset. Anything above 120/80 Mild to moderate and progresses slowly but still needs medical attention. 140/90 -179/19 E.g. Atherosclerosis 2. What hypertension did this woman display, give reasons for your answer? Primary benign hypertension  Type 2 diabetes at age 56 (related to lifestyle, not another disease) 3. What complications (others than those listed above) can arise from this type of hypertension? - Kidney, liver, spleen, heart failure  any organ that passes blood which affects BP. - Thyroid problems - Obstructive sleep apnoea - Aneurism (swelling vessel) - Eye problems - Oedema - Thrombus (clots) - Embolus (Blood clot that moves in the vessels) 4. What was a likely cause of death in this woman and why? Left ventricle pumps blood out to the body. During left ventricular hypertrophy, the thickened heart wall can become stiff. Blood pressure in the heart increases. The changes make it harder for the heart to effectively pump blood. Eventually, the heart may fail to pump with as much force as needed. Decompensated heart failure  When cells are under pressure, they change their size (hypertrophy), number (hyperplasia) and type (metaplasia) 5. On a separate note; what is “white coat” hypertension and how is it significant? White coat hypertension, a condition in which a patient's blood pressure readings are higher when taken at the doctor's office compared to other settings  anxiety, stress Causes wrong readings, misdiagnoses

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