4/14 - cardiac, PAD

revascularization : 혈관재형성, 혈관재생
rehabilitation : 재활치료

outpatient : 외래환자

embarrassed : 어색한, 당황스러운, 쑥스러운

resume : 재개하다

flight of stairs : 가파르게 난 계단, 계단 층계

 

 

PNS 의학용어 :Peripheral Nervous system

P.N.S series?? Para nasal sinuses 부비강 

 

insufficiency : 심부전

incompetent : 무능한

typically : 보통, 일반적으로

refer : 지시하다, 나타내다; 주목시키다 ((to))

atherosclerosis : 아테롬성 동맥 경화증

manifestation : 징후

referral : (사람을 전문적인 도움을 받을 곳으로) 보내기[소개/위탁]

inspect : 점검하다

cessation : 중지, 중단

Varenicline : 금연치료에 보조적으로 사용되는 약물

smoking cessation → may change behavior & mood, can't sleep,, not loose weight. can use a nicotine replacement ( gum, candy etc,, ) it can combine varenicline ( med ).

 

if cardiac clients can walk 1 block or climb 2 flights of stairs without symptoms, the client can resume sexual activity safely.
cardiac clients, sexual activity 기간 상관 없음.

Chest drainage >100 mL/hr should be reported to the HCP. 

 

intermitent : 간헐적인 

claudication : 파행, 절뚝거림

 

The most concerning findings include:

• Cool skin temperature:  Skin temperature that is cool to touch is associated with impaired perfusion.  This is especially concerning when it occurs in a localized area (eg, lower left extremity) along with other findings associated with impaired perfusion (eg, decreased leg hair).
• Decreased palpable pulses:  Decreased palpable pulses indicate impaired perfusion to the affected area.  This finding is concerning for peripheral artery disease.
• Delayed capillary refill time (ie, >3 sec):  Delayed reperfusion to distal extremities is concerning for impaired perfusion (eg, peripheral artery disease) or fluid volume deficit
  
  This client has a history of chronic obstructive pulmonary disease, and the lung examination findings (ie, decreased breath sounds throughout and prolonged expiration) are expected. ,,,환자 history 보고 expected symptom 배제하기.

incompetent : 무능한

Chronic venous insufficiency occurs when long-term venous hypertension (due to extensive standing, obesity, or thrombus) causes venous distension and valvular damage in the lower extremities.  Incompetent valves are unable to prevent the backflow of blood, leading to significant slowing or standstill of venous blood (ie, venous stasis) in the affected lower extremity.  Peripheral edema occurs as fluid leaves the vascular space and enters the surrounding tissues.  Associated pain typically improves with elevation due to increased venous return, which relieves the pressure from edema.

 

Peripheral artery disease (PAD) refers to a narrowing of the arteries, typically from atherosclerosis (ie, plaque deposits from cholesterol and fat), resulting in decreased perfusion.  The hallmark clinical manifestation of PAD is ischemic lower extremity pain during periods of exertion (due to increased oxygen demand) that is relieved with rest (ie, intermittent claudication).  This can progress to pain at rest as the disease progresses.  Other manifestations of PAD are caused by decreased perfusion (nutrition) and include brittle nails, decreased leg hair, decreased peripheral pulses, and skin temperature cool to touch.  Clients with PAD can develop ischemic ulcers between the toes, which can be painful and lead to infection (eg, gangrene).

peripheral artery disease (PAD) to prevent tissue necrosis.

Management of peripheral artery disease (PAD) is aimed at cardiovascular risk factor modification and treatment of claudication symptoms.  Expected prescriptions include:

• Antiplatelet medication (eg, aspirin, clopidogrel) to prevent further thrombus development.
• Lipid-lowering medication (eg, HMG-CoA reductase inhibitor [statin]) to decrease atherosclerosis and improve blood flow.
• Antihypertensive medication (eg, ACE inhibitor) to lower blood pressure and promote vasodilation, which improves blood flow.
• Hemoglobin A1c level to check average blood glucose levels over the past 3 months; hyperglycemia causes inflammatory vascular changes that may contribute to PAD.  If the client's hemoglobin A1c is high, blood glucose control is necessary.
• Referral for supervised exercise therapy to promote collateral circulation and distal tissue perfusion with a gradual increase in exercise.

Graduated compression stockings to the left lower extremity would be unexpected to PAD

Home management of peripheral artery disease (PAD) focuses on symptom management and lifestyle modifications to prevent worsening PAD, such as:

• Incorporating more fruits and vegetables into the diet and consuming low-cholesterol, low-fat foods to reduce formation of additional arterial plaques (Option 2)
• Inspecting the feet daily for wounds because decreased perfusion can lead to small foot ulcerations or gangrene (Option 3)
• Exercising regularly with light physical activity, stopping if ischemic pain develops, and gradually increasing the intensity to promote development of collateral arteries, improve perfusion, and decrease exertional pain (Option 5)