Precipitating factor Predisposing factor

smoking 20 pack years

male
betle nut chewing
age 71
family History of HPN
cardiac dysrhythmia
Smoking

Betle nut chewing

scan:
tine plaque deposition on the blood Ct
vessels
atherosclero
sis

Arecoline is being released

Activation of
parasympathetic
nervous system

Narrowing of the blood vessel

Hypoperfusion to
vital organs
Muscarinic

Muscarinic

Decreased heart rate

Vasodilation

Decreased conduction of SA node and AV node

Hypotensio
Reduce contractility of cardiac muscle
Hypoperfusion to vital organs
Decreased cardiac
output
Kidney compensatory mechanism

Fluid retention
related increased
Na+

Activation of RAAS

Increased cardiac
output

Hypertensi
on

Increased pressure on the blood vessel walls

Rupturing of
atheroma

Formation of
atheroma

Damage to blood vessels

Increased platelet
aggregation

Clot may occlude delicate organs

Cerebrovascular area

Amlodipine

Losartan

Nausea &
vomiting
hypotension

Hypotension

Decreased perfusion on the cerebellum

Ischemic stroke

Ct scan:
ischemia on the
cerebellar area

Decreased perfusion to the kidney

(hypoperfusion)

Imbalance nutrition:
less than body
requirement related
to nasogastric tube
feeding

Renal ischemia

Impaired
physical mobility
Increased
circulating fluid
volume

Fluid retention

Increased
cardiac output

Unresolved

Kidney injury

Chronic kidney disease stage 4

Edem
a
Vasoconstriction

Impairment
in the
neuronal activity
Impaired
Impaired
physical
peripheral
tissue
mobility
perfusion

Serum creatinine:
2.10 mg/dl
(high)

Fluid and
electrolyte
imbalance

nce in the cation and anions in

the extracellular
and
Coldintracellular
clammy
Heaviness
on
extremities
the lower
extremity
equilibrium in the repolarization and depolarization of neurons

Neurons are irritable

Erratic release of neurotransmitters

Mood swings
delirium
depression

Organisms enters
the respiratory
tract by

Lose effectiveness
of defense
mechanism
Microorganisms
infects Type 2
alveolar cells

Microorganisms multiply and spread from alveolar to alv

Release of damaging toxins

Hypermetabolic state

Activates inflammatory cascade

Increase in body core temperature
Release of chemical mediators

Mood
swings
depression

Delirium

Hyperthermia
Vasodilation

Vasodilation

Increase mucus
production

Irritation of
airway

Flooding of exudation in the

alveoli
Fluid shifting from alveoli to
interstitial space

Pulmonary
congestion
Pulmonary edema

Lung
consolidation

Airway constriction
Activity
intolerance r/t
Difficulty
in
decrease
oxygen

Increase capillary
permeability
Irritation of
airway