NR 507 Week 2 Clinical Reasoning Webinar Transcript

NR507 | Week 2 Clinical Reasoning Webinar Transcript [01:55] Okay, and so why is it important to understand shared challenges in oxygena琀椀on among these three diseases? Well, because you think about pa琀椀ents, we have to have a holis琀椀c approach of managing the pa琀椀ent. It o昀琀en takes a mul琀椀disciplinary team and face it. [02:19] How many 琀椀mes have you had pa琀椀ents that had all of these at one 琀椀me heart failure? Well, maybe they had coronary artery disease that did lead to heart failure and they have anemia on top of that. And so, yeah, so they can have so you've got three of these that is working against one individual and they're in some form. They're going to have impaired oxygena琀椀on status. [02:43] And so it's really helpful in terms of early detec琀椀on and interven琀椀on because, you know, we can screen for coronary artery disease before it even ever gets to a heart failure state stage. And so we can screening is really important and we can provide proac琀椀ve treatments lifestyle management symptom management. Everything is done to improve oxygena琀椀on and reduce cardiac stress on the heart. [03:10] And a lot of pa琀椀ent educa琀椀on, diet, nutri琀椀on, exercise, and hydra琀椀on. But we're going to separate these out in three di昀昀erent ways in just a few minutes. We'll talk about each of them. But over the next I'm just really commi琀琀ed for bringing home the point about the rela琀椀onship between anemia coronary artery disease and heart failure before we actually talk about them separately. [03:36] So with, so there's a rela琀椀onship between anemia and coronary artery disease. So anemia can actually exacerbate coronary artery disease by increasing myocardial o2 demand while simultaneously reducing oxygen supplies. So anemia is what? Well, [03:57] Remember that hemoglobin carries oxygen to the 琀椀ssues. And so if the person is anemic, then that's going to cause the body to... [04:10] I'm not ge琀��ng my kidneys or ge琀��ng perfused. My my spleen is not ge琀��ng perfused. My veins and arteries are ge琀��ng perfused. And so the heart automa琀椀cally starts thinking, wait a minute, I need to work harder to get the oxygen out. And so that's why there's an increased myocardial oxygen demand because it's not ge琀��ng to the 琀椀ssues. There's not enough hemoglobin in the person that who has anemia. And so [04:40] Then the heart starts kicking in as a compensatory mechanism. And so it doesn't really help because their person is anemic, but the heart does try to step in and help. [04:53] alleviate that so it can lead to a lot more frequent and severe ischemic episodes, including cardiac ischemic episodes, worsening coronary artery disease symptoms. And then actually impact there's also an impact of coronary artery disease on anemia coronary artery disease can contribute to anemia through chronic in昀氀amma琀椀on and reduced renal func琀椀on which [05:21] Impairs erythropoiesis red blood cell produc琀椀on. We'll talk a li琀琀le bit more about erythropoiesis. I'll men琀椀on a li琀琀le bit more tonight, but when we get into week 4