Care of Patients with Vascular Problems

Question 1

Arteriosclerosis:

Answer 1

thickening, hardening of the arterial wall that is often associated with aging

Question 2

Atherosclerosis:

Answer 2

type of arteriosclerosis, involves the formation of plaque w/in the arterial wall and is the leading risk factor for cardiovascular disease

Question 3

Palpate each carotid artery separately to

Answer 3

prevent blocking blood flow to the brain

Question 4

What indicates hypertriglyceridemia?

Answer 4

level of 160 mg/dL or above in men

Women should have level below 135

Question 5

Recommendations for nutrition: Arteriosclerosis

Answer 5

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

Question 6

Physical activity Arteriosclerosis

Answer 6

3-4 X a week

Question 7

Drug therapy: Arteriosclerosis

Answer 7

3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors = reduce cholesterol

Question 8

Complementary therapies: Arteriosclerosis

Answer 8

Nicotine acid or niacin
B vitamin
lower LDL-C
very low density lipoprotein (VLDL)
Increase HDL-C levels

Question 9

4 control systems play a major role in maintaining BP:

Answer 9

Arterial baroreceptor system
Regulation of body fluid volume
The renin angiotensin aldosterone system
Vascular autoregulation

Question 10

Found primarily in the carotid sinus, aorta, and wall of the left ventricle

Answer 10

arterial baroreceptors

Question 11

Changes in fluid volume also affects the

Answer 11

systemic arterial pressure

Question 12

Keeps perfusion in the body relatively constant, appears to be important in causing hypertension

Answer 12

Vascular autoregulation

Question 13

the most common type of hypertension and is not caused by existing health problem

Answer 13

Essential (primary)

Question 14

Primary hypertension results in

Answer 14

damage to vital organs by causing medial hyperplasia of the arterioles

Question 15

Secondary hypertension=

Answer 15

specific disease states and drugs can increase person’s susceptibility to this

Question 16

a severe type of elevated BP that rapidly progresses

Answer 16

Malignant hypertension

Question 17

symptoms of malignant hypertension =

Answer 17

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

Question 18

Etiology and genetic risk =

Answer 18

Kidney disease: renal artery stenosis (RAS)
Primary aldosteronism
Pheochromocytomas
Cushing's syndrome
Drugs

Question 19

Adrenal mediated hypertension is due to

Answer 19

primary excesses of aldosterone

Question 20

Primary aldosteronism, excessive aldosterone causes

Answer 20

hypertension and hypokalemia

Question 21

Pheochromocytomas:

Answer 21

tumors that originate most commonly in the adrenal medulla and result in excessive secretion of catecholamines

Question 22

Cushing’s syndrome:

Answer 22

excessive glucocorticoids are excreted from the adrenal cortex

Question 23

Drugs that cause secondary hypertension

Answer 23

estrogen
glucocorticoids
mineralocorticoids
sympathomimetics
cyclosporine
erythropoietin

Question 24

Manifestation of hypertension:

Answer 24

headaches
facial flushing
dizziness
fainting

Question 25

Expected outcomes for hypertension:

Answer 25

Verbalize his or her individualized plan of care for hypertension Expected to adhere to the plan of care, including making necessary lifestyle changes

Question 26

Interventions: Lifestyle changes for hypertension

Answer 26

``` Restrict sodium intake Reduce weight Use alcohol sparingly Exercise 3-4 X a week Use relaxation techniques to reduce stress Avoid tobacco and caffeine ```

Question 27

Other Interventions: for hypertension

Answer 27

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

Question 28

hypertensive crisis:

Answer 28

severe elevation in BP (greater than 180/120) can cause organ damage in kidneys and heart

Question 29

Peripheral vascular disease (PVD):

Answer 29

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

Question 30

PAD results of

Answer 30

systemic atherosclerosis: partial or total arterial occlusion, decreases perfusion in lower extremities

Question 31

Patho of PAD:

Answer 31

Inflow obstructions involve the distal end of the aorta and the common, internal, and external iliac arteries

Question 32

Classic leg pain known as

Answer 32

intermittent claudication

Question 33

Rest pain =

Answer 33

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

Question 34

Patients with inflow disease:

Answer 34

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

Question 35

Dependent rubor may occur when

Answer 35

the extremity is lowered

Question 36

Arterial ulcers develop on the

Answer 36

toes (more of the big toe)

Question 37

Imaging assessment for PAD:

Answer 37

MRA (angiography) | CTA

Question 38

Other diagnostic assessment for PAD:

Answer 38

Doppler probe ABI (less than 0.9 = PAD) Exercise tolerance test Plethysmography

Question 39

Patient with outflow disease:

Answer 39

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

Question 40

Interventions for PAD:

Answer 40

first must be assessed to determine if the altered tissue perfusion is due to arterial disease, venous disease, or both

Question 41

Nonsurgical management for PAD:

Answer 41

Collateral circulation: provides blood to the affected area through smaller vessels that develop and compensate for the occluded vessels

Question 42

Drug therapy for PAD:

Answer 42

Antiplatelet agents | Do not eat grapefruit or juice

Question 43

Invasive nonsurgical procedures: PAD

Answer 43

percutaneous vascular interventions also called percutaneous transluminal coronary angioplasty (PTCA) Artherectomy

Question 44

Surgical management: PAD

Answer 44

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

Question 45

Preop care for PAD

Answer 45

baseline vitals

Question 46

Operative care PAD:

Answer 46

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

Question 47

Postop care PAD:

Answer 47

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

Question 48

Emergency thrombectomy (removal of the clot):

Answer 48

the surgeon may perform at the bedside, most common treatment for acute graft occlusion

Question 49

DVT presents a greater risk for

Answer 49

PE, a dislodged blood clot travels to the pulmonary artery - a medical emergency

Question 50

stasis of blood flow, endothelial injury, and or hypercoagulability, known as

Answer 50

Virchow's triad

Question 51

9 characteristics of DVT:

Answer 51

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

Question 52

Precautions of DVT:

Answer 52

Avoid oral contraceptives Hydrate Exercise

Question 53

DVT symptoms:

Answer 53

calf or groin tenderness and pain and sudden onset of unilateral swelling of the leg

Question 54

preferred diagnostic testing for DVT:

Answer 54

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

Question 55

Interventions of DVT: nonsurgical management=

Answer 55

Rest Drug therapy: Anticoagulants, unfractionated heparin therapy Alternative to unfractionated heparine= low-molecular-weight heparin, warfarin therapy, thrombolytic therapy(fibrinolytics)

Question 56

To prevent DVT while on unfractionated heparin:

Answer 56

low doses subcutaneously for high risk patients

Question 57

Recommendations for people discharged with DVT=

Answer 57

Compliance w/ meds dietary advice Follow up monitoring Info about adverse reactions

Question 58

Avoid w/ Warfarin=

Answer 58

``` Allopurinol NSAIDs Acetaminophen Vit E Histamine blockers Cholesterol reducing drugs Antibiotics Oral contraceptives Antidepressants Thyroid drugs Antifungal agents Other anticoagulants Corticosteroids Herbs ```

Question 59

Foods to take with Warfarin=

Answer 59

``` Small amounts of Vit K: Broccoli Cauliflower Spinach Kale Other green leafy vegetables Brussel sprouts Cabbage Liver ```