X.

Comprehensive Pathophysiology and Management

Non-Modifiable Risk Factors
Age (Above 40 years old)
Heredity (Hypertension)

Atheroscleros

Aortic Stenosis/Insu

Overloading of the V

Reduced myocardial C

Decreased Cardiac W
Decreased Diastoli
Obstruction of Left Atria

Increase Left Atrial P

LEFT - SIDED Congestive

Blood dams back into the Pulmonary

Decrease Stroke V
Capillary Bed

Pressure of blood into the Pulmonary

Capillary bed increases
Decrease Tissue Pe

Fluid shifts into the intraalveolar and

interalveolar spaces Increase Cellular H

Pulmonary Edema
 Ineffective Airway
Clearance
Signs & Symptoms: wheezing, SIGNS and SYMPTOMS
productive cough, dyspnea Dyspnea
Paroxysmal Nocturnal Dyspnea
Management: 1) Monitor respirations Orthopnea
and breath sounds 2) Suction oral as
ordered 3) Elevate head of bed/change
Rales/Crackles
position every 2 hours and prn Wheezing
4)Encourage DBE and CE Dizziness
Fatigue
Weakness
S3 heart sounds

Activity Intolerance
Signs & Symptoms: Fatigue, weakness
Management: 1)Assess cardiopulmonary response to physical activity, including vital signs 2) Assist with
activities 3)Evaluate clients actual and perceived limitaions

Reference:

Quiambao-Udan.(2009).Concepts and Clinical Application (1st Edition).Philippines: Guiani Prin

Huether and McCance.(2002).Understanding Pathophysiology.
Brunner and Suddarth.(2006). Medical-Surgical Nursing(9th Edition ). Philadelphia;Lipincott W
 Modifiable Risk Factors
Stress, Diet, Cigarette smoking, Alcohol

Atherosclerosis

Aortic Stenosis/Insufficiency

Overloading of the Ventricle

educed myocardial Contractility

Decreased Cardiac Workload

Decreased Diastolic Filling
bstruction of Left Atrial Emptying

Increase Left Atrial Pressure

T - SIDED Congestive Heart Failure

Decrease Cardiac Output

Signs & Symptoms: braycardia, dyspnea, clammy skin,

capillary refill (3-4 secs)
Decrease Stroke Volume

Management: 1) Position client in a semi-Fowler's position

2) Administer oxygen via mask/ventilator 3)Monitor vital
signs frequently 4)Instruct client to avoid or limit activities
that may stimulate Valsalva response(i.e rectal
Decrease Tissue Perfusion stimulation, bearing down during bowel movement)

Decrease blood flow to the organs and

Increase Cellular Hypoxia kidneys

RAAS Stimulation
 Vasoconstriction and
OMS reabsorption of Sodium and
Water
Dyspnea
Increase ECF Volume

Increase Total Blood Volume and

Increase Systemic Blood
Pressure

s Risk for Fluid Volume Excess

Management: 1) Administer diuretics as prescribed 2)Elevate extremety 3) Do log
rolling every two hours 4)Massage bony prominences

ital signs 2) Assist with

ippines: Guiani Prints House

delphia;Lipincott Wiilliams Wilkins

X. Comprehensive Pathophysiology and Management

RISK FACTORS
Respiratory infections (Pulmonary tuberculosis
Smoking
Environmental Pollutant

Chronic irritation of airways

Increase in size and Inflammation

production of goblet
cells

Release of bradykinin,
prostaglandin, histamin

Fluid/Cellular
exudation

Edema of mucus
membranes

Hypersecretion of mucus

Increase in mucus production

Ineffective airway
clearance Airway obstruction
Signs & Symptoms:
productive cough,
wheezes/crackles
Persistent cough

Nursing Interventions:
1. Auscultate breath
sounds 2.Observe for
signs of resp. distress
3.Encouraged deep
breathing/coughing Impaired gas exchange
exercises Signs & Symptoms: use of accessory
muscles, in moderate high back rest,
presence of mucus secretions

Nursing Interventions: 1. Regularly

monitor respiratory rate,pattern, pulse
2.Monitor pulse oximetry 3. Assess skin
and mucus membranes for cyanosis
4.Administer oxygen(1-2LPM) 5.Assist in
high-fowler's position
ement

Decreased hemoglobin
Production

Risk for infection

Signs & Symptoms: 1.
Capillary refill = within 3
secs. 2. Lab results = low
Hgb level

Nursing Interventions:
1.Monitor body temp. 2.
observe for sputum, noting
for color, amount,
consistency

Vasoconstriction

Decreased Tissue
Perfusion
Signs & Symptoms:
restlessness, cold clammy
skin, BP = 150/90

Nursing Interventions:
1.Observe skin color,
moisture 2.Monitor blood
pressure 3.Provide calm,
restful environment

Risk for activity

intolerance
Nursing Interventions:
1.Asses physical condition
and baseline activity level
2.Monitor oxygen saturation
level 3.Advised to ask help
in performing activities of
daily living