Cardiovascular (Exam 2) Flashcards
Common Perfusion Concerns
-Hypertension
-Hypotension
-Hyperlipidemia
-Venous Thromboembolism
Hypertension
-High blood pressure. Pressure in arteries that is higher than should be
-Starts to break down arteries and cause bad effects to walls
-Changes in arterial walls cause increased peripheral vascular resistance
Peripheral vascular resistance
Amount of effort the heart has to overcome to get blood out of heart into periphery
What does high PVR do?
-Wears your heart out and drives blood pressure up
-Cause heart failure
HTN left untreated
-Decrease of blood flow (perfusion) to Heart, Brain, and etc
Two stages of HTN
Stage 1 = 130-139 or 80-89
Stage 2 = 140 or higher or 90 or higher
Crisis = higher than 180 and/or higher than 120
Factors Influencing Blood Pressure
-Age
-Stress (Sympathetic NS)
-Ethnicity (AA and Hispanics)
-Genetics (Runs in family)
-Gender (After puberty males increase) (After menopause womens goe= higher)
-Daily Variation. (Midnight - 3 am) (Lowest Point)
Smoking and BP
Vasoconstriction
smoking cessation has immediate benefit
HTN: Risk Factors Modifiable
-Diabetes Mellitus (DM) (Take insulin to keep blood sugar normal limits)
-Elevated serum lipids (Alter diet)
-Excess Sodium intake (Causes water retention) (Salt Sucks)
-Obesity
-Sedentary Lifestyle
-Stress
HTN: Risk factors: Non-Modifiable
-Family History (Genetics)
-Race
-Increase Age
-Gender
-Chonic Kidney Disease
-OSA
HTN: Diagnosis
-Take average of 2 or more readings on at least 2 different health care visit is above 120/80
-Might check an EKG or CXR to evaluate the heart
Hypertension S/S
-Dizziness
-Headache
-Visual Problems
-Heart Palpations
-Red face and angry
-Sore knee (not common)
Complications of HTN
-Cardiovascular Disease
-Myocardial Infarction
-Heart Failure
-Stroke
-Peripheral Vascular Disease
-Renal and Retinal Disease
HTN: Nursing Care and Treatment
-Back to basics: Blood Pressure Measurement
-Implement a patient-centered plan for lifestyle modifications
-Goal: Prevent HD, CVA, or Renal Disease
HTN: Nursing Care
-Determine risk factors and assist with changing modifiable risk factors
-Healthy heart nutrition
-Reduce weight
-Stop smoking
-Manage BP meds
-Patient Education
HTN: Patient Education
-Develop a BP screening program based on BP. (Does patient have cuff, do they know how to use and record, do they know when to notify HCP)
-Explain potential dangers
-Teach how to manage BP
-Drug therapy education
HTN: When to seek immediate care
-BP: >180/110
-Severe Headache
-Dyspnea
-Chest pain (Decrease perfusion to heart)
-Loss of vision
-Cant speak with nosebleed
-Anxiety
-Unresponsive
HTN: Lifestyle Modificaitons
-Manage BP
-Control Cholesterol
-Reduce BS (Maintain tight glucose control)
-Stop smoking
-Stress modificaitons
DASH Diet
-Dietary Approaches to Stop Hypertension
-Rich in fruits and veggies
-Restrict sodium intake (decided by provider)
Hypotension
-SBP falls < 90
-Patient is Symptomatic (key)
-Organs are not getting enough getting enough perfusion
Hypotension: Causes
-Dilation of arteries
-Loss of blood volume (Dehydration or bleeding out)
-Failure of heart muscle to pump
Hypotension: S/S
-SKIN = Pallor, mottle, clammy
-Decreased perfusion to brain (light headedness, dizziness, syncope, confusion
-Blurred vision
-Chest Pain (Angina)
-Increased HR (rapid or weak)
-Decrease in urine output (not perfusion to kidenys well)
How many mL of urine per hour should you produce
30 mL
Hypotension: Treatment
-TREAT THE CAUSE
Nursing Implementation: Hypotension
-Monitor VS more frequently
-Assess for symptoms
-Interventions aimed to treat the cause
-Consider adding more salt to diet
-Drink more water or IVF’s
-Compression hose (Promote Venous Return)
Orthostatic Hypostension
-Stand up and Blood Pressure falls.
-Safety issue
Orthostatic Hypotension: What happens in healthy indviduals?
-Good compensatory mechanism and there is no decrease in perfusion to the brain. The blood doesn’t pull to gravity
People who get orthostatic hypotension
People who do not have high blood volume like elderly people or people who have been immobilized for a long period of time
Orthostatic Hypotension: Diagnoses
Diagnosis: SBP-decrease of 20 mmHg or more. DBP-decrease of 10mmHg or more
How to check orthostatic hypotension
-Measure BP and HR supine, sitting, and standing
-Measure BP within 3 minutes of position changes
-Monitor BP, Pulse, and Symptoms
Orthostatic Hypotension: Nursing Care
-Dangle feet at bedside
-DO NOT cross legs
-Early ambulation
-If immobile, balance rest and activity
-Perform isometric exercises (Squeezing rubber ball or towel) (helps raise BP before standing)
-Wear compression hoes (Prevent blood pooling)
Hyperlipidemia
-To many lipids in the blood
-Cholesterol and triglycerides (most common fat in the body)
Hyperlipidemia: Why do we care?
-Form hard deposit inside arteria
-Worry about it building up on the arterial walls causing it to narrow and less elastic/flexible
-Atherosclerosis- CAD, PAD
CAD
Coronary Artery Disease
Atherosclerosis in the heart
PAD
Atherosclerosis in peripheral
Hyperlipidemia: Diagnostic Test
-Test at age of 20. Test 4-6 years
-At age 40 - HC asses 10 year risk for experincing cardiovascular disease or stroke
-Fasting 9-12 hours- if not fasting LDL value will be affected
-Cholesterol < 200 mg/dL
-LDL - (bad guys) < 130 mg/dL
-HDL: Male >45: Women > 55
Hyperlipidemia: Nursing Care
-Check change control
-Maintain Healthy Weight
-Be active
-Limit smoking and alcohol
-Dietary modifications
-Lipid lowering drug therapy
Hyperlipidemia: Dietary Modifications
-Reduce saturated and trans fat
-Increase in complex carbohydrates and fiber
-Limit major sources of cholesterol (Red meat, egg yolks, Whole milk)
-Limit alcohol and simple sugars
Venous Thromboembolism: What is it? Who is at risk?
VTE: Obstruction of a blood vessel by a blood clot that has become dislodged from another site in circulation
DVT = Deep vein thrombus (cant inspect it)
AT risk: = Venous Stasis (Blood pooling in vein) (Surgery, obesity, immobility, pregnancy belly impeding venous return back to the heart)
AT risk: = Hypercoagulability (Thick Blood) (Dehydrated)
AT risk: = Endothelial damage. (IV fluid and drugs) (IV insertion sight) (Fraction femur) (Hx of them or DM)
DVT by itself is not concerning
DVT is concerning if it dislodges which is an embolus. Which travels to right ventricle which then gets pumped and stuck into the lungs (Pulmonary Embolus) (Instant Death)
VTE: S/S
-Localized redness, tenderness, swelling over vein sites
-Warmth, tenderness, firmness of muscle in calf
-Complaints of calf pain with ambulation
-Usually unilateral
VTE: Assessment
Palpation for S/S of inflammation/ phlebitis. Palpate and see how they react. With pain you know that is tender and patient will react
Typically can feel before you can see. VTE can be deep enough that we cant see.
VTE: Diagnoiss
Ultrasound is the only reliable tool to detect.
PA and Hx
VTE: Nursing care
-Assess for S/S
-Measure calf circumferences
-Calf tenderness / Phlebitis check
VTE: How to prevent
-EARLY AMBULATION
-TEDS (tips of toes exposure to check for perfusion)
-SCD’s (Sequential Compression Devices)
-Ankle pumps
VTE: Treatment
-Prevention is key
-Anticoagulation
-Thrombolytic
-IVC filter (Vena cava device. Strainer inside the vena cava. It is filter that will catch clots before lungs) (People with history and has clots form alot)
