Care of Patients with Vascular Problems Flashcards
Arteriosclerosis:
thickening, hardening of the arterial wall that is often associated with aging
Atherosclerosis:
type of arteriosclerosis, involves the formation of plaque w/in the arterial wall and is the leading risk factor for cardiovascular disease
Palpate each carotid artery separately to
prevent blocking blood flow to the brain
What indicates hypertriglyceridemia?
level of 160 mg/dL or above in men
Women should have level below 135
Recommendations for nutrition: Arteriosclerosis
Intakes of veggies, fruits, whole grains
Consume low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts
Limit intake of sweets, sugar-sweetened beverages, and red meats
5% to 6% of calories from saturated fat
Reduce trans fat
Physical activity Arteriosclerosis
3-4 X a week
Drug therapy: Arteriosclerosis
3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors = reduce cholesterol
Complementary therapies: Arteriosclerosis
Nicotine acid or niacin B vitamin lower LDL-C very low density lipoprotein (VLDL) Increase HDL-C levels
4 control systems play a major role in maintaining BP:
Arterial baroreceptor system
Regulation of body fluid volume
The renin angiotensin aldosterone system
Vascular autoregulation
Found primarily in the carotid sinus, aorta, and wall of the left ventricle
arterial baroreceptors
Changes in fluid volume also affects the
systemic arterial pressure
Keeps perfusion in the body relatively constant, appears to be important in causing hypertension
Vascular autoregulation
the most common type of hypertension and is not caused by existing health problem
Essential (primary)
Primary hypertension results in
damage to vital organs by causing medial hyperplasia of the arterioles
Secondary hypertension=
specific disease states and drugs can increase person’s susceptibility to this
a severe type of elevated BP that rapidly progresses
Malignant hypertension
symptoms of malignant hypertension =
morning headaches, blurred vision, and dyspnea and/or symptoms of uremia (accumulation in the blood of substances ordinarily eliminated in the urine)
Diastolic pressure is greater than 150 mm Hg or greater than 130
Etiology and genetic risk =
Kidney disease: renal artery stenosis (RAS) Primary aldosteronism Pheochromocytomas Cushing's syndrome Drugs
Adrenal mediated hypertension is due to
primary excesses of aldosterone
Primary aldosteronism, excessive aldosterone causes
hypertension and hypokalemia
Pheochromocytomas:
tumors that originate most commonly in the adrenal medulla and result in excessive secretion of catecholamines
Cushing’s syndrome:
excessive glucocorticoids are excreted from the adrenal cortex
Drugs that cause secondary hypertension
estrogen glucocorticoids mineralocorticoids sympathomimetics cyclosporine erythropoietin
Manifestation of hypertension:
headaches
facial flushing
dizziness
fainting
Expected outcomes for hypertension:
Verbalize his or her individualized plan of care for hypertension
Expected to adhere to the plan of care, including making necessary lifestyle changes
Interventions: Lifestyle changes for hypertension
Restrict sodium intake Reduce weight Use alcohol sparingly Exercise 3-4 X a week Use relaxation techniques to reduce stress Avoid tobacco and caffeine
Other Interventions: for hypertension
Complementary therapies: garlic and coenzyme Q10
Drug therapy: antihypertensives, Lipid-lowering treatment, diuretics (1st defense), calcium channel blockers, ACE inhibitors, aldosterone receptor antagonists, beta blockers, renin inhibitors
hypertensive crisis:
severe elevation in BP (greater than 180/120) can cause organ damage in kidneys and heart
Peripheral vascular disease (PVD):
disorders that change the natural flow of blood through the arteries through the arteries and veins of peripheral circulation, causing decreased perfusion to body tissues
Implies more arterial than venous
PAD results of
systemic atherosclerosis: partial or total arterial occlusion, decreases perfusion in lower extremities
Patho of PAD:
Inflow obstructions involve the distal end of the aorta and the common, internal, and external iliac arteries
Classic leg pain known as
intermittent claudication
Rest pain =
begin while the disease is still in the stage of intermittent claudication, is a numbness or burning sensation, often described as feeling like a toothache that is severe enough to awaken patients at night
Patients with inflow disease:
have discomfort in the lower back, buttocks, or thighs
Mild: discomfort after walking about 2 blocks
Moderate: pain after walking one or 2 blocks
Severe: pain walking less than one block
Dependent rubor may occur when
the extremity is lowered
Arterial ulcers develop on the
toes (more of the big toe)
Imaging assessment for PAD:
MRA (angiography)
CTA
Other diagnostic assessment for PAD:
Doppler probe
ABI (less than 0.9 = PAD)
Exercise tolerance test
Plethysmography
Patient with outflow disease:
describe burning or cramping in the calves, ankles, feet, and toes
Instep or foot discomfort indicates an obstruction below the popliteal artery
Mild: pain after walking 5 blocks
Moderate: pain after walking 2 blocks
Severe: cannot walk more than one-half a block
Interventions for PAD:
first must be assessed to determine if the altered tissue perfusion is due to arterial disease, venous disease, or both
Nonsurgical management for PAD:
Collateral circulation: provides blood to the affected area through smaller vessels that develop and compensate for the occluded vessels
Drug therapy for PAD:
Antiplatelet agents
Do not eat grapefruit or juice
Invasive nonsurgical procedures: PAD
percutaneous vascular interventions also called percutaneous transluminal coronary angioplasty (PTCA)
Artherectomy
Surgical management: PAD
Arterial revascularization
Inflow procedures: bypassing arterial occlusions above superficial femoral arteries (SFAs)
Outflow procedures: surgical bypassing of arterial occlusions at or below the SFAs
Graft materials
Preop care for PAD
baseline vitals
Operative care PAD:
For open aortoiliac and aortofemoral bypass surgery: the surgeon makes a midline incision into the abdominal cavity to expose the abdominal aorta, with additional incisions in each groin
Open axillofemoral bypass: surgeon makes an incision beneath the clavicle and tunnels graft material subcutaneously with a catheter from the chest to the iliac crest, into the groin incision, where it is sutured in place
Postop care PAD:
Deep breathing every 1-2 hr using an incentive spirometer are essential to prevent respiratory complications
NPO
Nurse marks the site where the distal pulse is best palpated or heard by Doppler
Emergency thrombectomy (removal of the clot):
the surgeon may perform at the bedside, most common treatment for acute graft occlusion
DVT presents a greater risk for
PE, a dislodged blood clot travels to the pulmonary artery - a medical emergency
stasis of blood flow, endothelial injury, and or hypercoagulability, known as
Virchow’s triad
9 characteristics of DVT:
Active cancer, paralysis, or casting of extremity
Bedridden for more than 3 days
Major surgery with general anesthesia during the previous 3 months
Localized tenderness
Swelling of the entire leg
Calf swelling of greater than 3 cm larger than other leg
Pitting edema in one leg
Dilated superficial veins in one leg
Previous DVT
A score of 2 or more= likely to occur
Precautions of DVT:
Avoid oral contraceptives
Hydrate
Exercise
DVT symptoms:
calf or groin tenderness and pain and sudden onset of unilateral swelling of the leg
preferred diagnostic testing for DVT:
Venous duplex ultrasonography, a noninvasive ultrasound that assess the flow of blood through the veins in the arms and legs
-Other: Doppler flow studies
Impedance plethysmography
Interventions of DVT: nonsurgical management=
Rest
Drug therapy: Anticoagulants, unfractionated heparin therapy
Alternative to unfractionated heparine= low-molecular-weight heparin, warfarin therapy, thrombolytic therapy(fibrinolytics)
To prevent DVT while on unfractionated heparin:
low doses subcutaneously for high risk patients
Recommendations for people discharged with DVT=
Compliance w/ meds
dietary advice
Follow up monitoring
Info about adverse reactions
Avoid w/ Warfarin=
Allopurinol NSAIDs Acetaminophen Vit E Histamine blockers Cholesterol reducing drugs Antibiotics Oral contraceptives Antidepressants Thyroid drugs Antifungal agents Other anticoagulants Corticosteroids Herbs
Foods to take with Warfarin=
Small amounts of Vit K: Broccoli Cauliflower Spinach Kale Other green leafy vegetables Brussel sprouts Cabbage Liver
