Care of Patients with HTN and VTE/DVT Flashcards
Hypertension
most common health problem seen in primary settings. AHA 2017 guidelines below 130/80
desired BP in 60 yo and older
below 150/90
desired BP in younger than 60 yo
below 140/90
desired BP in patients with DM and heart disease
below 130/90
BP elevations…
results in damage to organs, causes thickening of the arterioles, as the blood vessels thicken, perfusion decreases and body organs are damaged
HTN is a major risk for…
stroke, myocardial infarction, kidney failure, death
Classifications of HTN
primary and secondary
primary classification of HTN
most common type, not caused by an existing health problem: can develop when a patient has any one or more of the risk factors: family history, African American ethnicity, hyperlipidemia, smoking, older than 60 or postmenopausal, excessive sodium and caffeine intake, overweight/obesity, physical inactivity, excessive alcohol intake, low potassium, calcium or magnesium intake, excessive and continuous stress.
secondary classification of HTN
results from specific diseases and some drugs. kidney disease is one of the most common causes of secondary HTN
physical assessment/clinical manifestations of HTN
most people have no symptoms, some patients experience headaches, facial flushing (redness), dizziness, fainting, blood pressure screenings (take in both arms, two or more readings at a visit, use appropriate size cuff)
orthostatic hypotension
decrease in BP with changes in position, 20 mmHg for systolic and or 10 mmHg for diastolic
psychosocial considerations for HTN
assess for stressors that can worsen HTN
Diagnostic assessment for HTN
no specific lab or x-rays are diagnostic of primary hypertension. secondary hypertension can be screened with labs specific to the underlying disease
ex: kidney disease
interventions for HTN
lifestyle changes, complementary and alternative therapies, drug therapy, avoid OTC medications (NSAIDS, decongestants)
lifestyle changes for HTN
dietary sodium restriction to less than 2g per day, reduce weight, use alcohol sparingly, exercise 3-4 times a week for 40 min, use relaxation techniques to decrease stress, avoid tobacco and caffeine
complementary and alternative therapies for HTN
biofeedback and meditation
Drug therapies for HTN
diuretics, calcium channel blocker, angiotensin converting enzyme (ACE) inhibitor, angiotensin II recpetor blockers (ARBs), Aldosterone receptors antagonists, beta adrenergic blockers,
Venous Thromboembolism VTE
includes deep vein thrombosis DVT and pulmonary embolism PE
Risk factors for VTE
stasis of blood, vessel wall injury, altered blood coagulation
VIRCHOW’S TRIAD
VTE prevention
prevention is key to address this challenge in health care: patient education, leg exercises, early ambulation, adequate hydration, graduated compression stockings, intermittent pneumatic compression, such as SCDs, venous plexus foot pump, avoid oral contraceptive, anticoagulant therapy
Symptoms of DVT
may be symptomatic or asymptomatic
classic s/s: calf or groin tenderness and pain AND sudden onset of unilateral swelling of the leg
induration (hardening) along the blood vessel
warmth, edema, redness
checking a Homan’s sign is not advised because it is an unreliable tool
physical exam findings may be adequate for diagnosis.
preferred diagnostics test for DVT
venous duplex ultrasonography: assess flow of blood through the veins of the arms and legs
lab testing for DVT
negative D-dimer test can exclude a DVT. used for the diagnosis of DVT when the patient has few clinical signs
goals for DVT interventions
prevent pulmonary emboli, further thrombus formation, or an increase in size of the thrombus.
symptoms of a pulmonary emboli
SOB, chest pain, acute confusion
intervention for DVT
elevate legs when in bed and chair, do not massage the effected extremity, drug therapy (anticoagulants: heparin, enoxaparin, warfarin)
Unfractionated Heparin Therapy (UFH)
Baseline PT, aPTT, INR, CBC with platelet count
antidote: protamine sulfate
heparin-induced thrombocytopenia (HIT)- life threatening complication
Low Molecular Weight Heparin (LMWH)
Preferred for prevention and treatment of VTE
antidote: protamine sulfate
May see an overlap of enoxaparin and warfarin given for treatment of DVT or PE
Non pharmacological interventions for DVT
thrombolytics and surgical management
Warfarin
given PO
monitor PT and INR
Assess for bleeding
antidote: vitamin K
teach patients to avoid foods with high concentrations of vitamin K
Which of the medications taken by Mrs. Adams places her
at increased risk for the development of DVT?
– 1. Antibiotics
– 2. Analgesics
– 3. Bronchodilator
– 4. Oral contraceptives
4
Which physical assessment should
the nurse perform to assist in the
diagnosis of suspected DVT?
–1. Measure calf circumference
bilaterally
–2. Observe for excessive bruising
–3. Perform test for Homan’s sign
–4. Auscultate for bruits
1
It is shift change. The oncoming nurse
enters the room and notices observable
hematuria in Mrs. Adam’s urinary
catheter.
- What action should the nurse initiate
first?
–1. Obtain a stat aPTT
–2. Stop the heparin infusion
–3. Assess vital signs
–4. Observe the surgical site for bleeding
2
After consulting with the HCP, the
nurse is to administer a heparin
antagonist.
*
* Which medication will be
administered?
–1. Vitamin K
–2. Protamine Sulfate
–3. Enoxaparin (Lovenox)
–4. Ticlopidine (Ticlid)
2
To which nursing diagnosis should
the nurse give the highest priority
when planning care for Mrs. Adams?
– 1. Pain related to decreased venous flow
– 2. Risk for injury (bleeding) related to
anticoagulant therapy
– 3. Impaired physical mobility related to
prescribed bedrest
– 4. Knowledge deficit related to lack of
discharge teaching
2
Mrs. Adams is transitioned to warfarin
by mouth. Mrs. Adams should receive
additional teaching about foods
- Which food should the nurse instruct
Mrs. Adams to avoid?
–1. Apple products
–2. Red meats
–3. Green leafy vegetables
–4. Nuts
3
