Care of Pt. with vascular problems Flashcards
hypertension
what can it lead to?
- High Blood Pressure (BP)
- Can lead to Stroke, MI, Kidney Failure, Death
AHA recommendations for hypertension
Maintain BP less than 130/80
JNC Recommendations
for hypertension
Over 60
- Maintain BP less than 150/90
Under 60
- Maintain BP less than 140/90
Arterial baroreceptor system
- Receptors located primarily in the carotid sinus, aorta, and left ventricle
- Alter HR, Vasoconstrict and Vasodilate
Regulation of body fluid volume
- Excess fluid – Rise in Cardiac Output → Increased BP
- Fluid Deficit – Decrease in Cardiac Output → Decreased BP
Renin-angiotensin-aldosterone system
- Kidneys recognize change in blood pressure/volume, oxygen levels and osmolarity
- Secrete renin when one of these becomes low → Triggers hormonal and blood vessel responses to raise BP
- *When BP is high secretion of renin should decrease
Vascular autoregulation
Ability of organ to maintain blood flow despite changes in BP
essential hypertension
& risk factors
- Most common, no known cause
- Results in damage to vital organs d/t thickening of arterial walls causing decreased perfusion
Risk factors
- Obesity, smoking, stress, family history
secondary hypertension
Occurs as a result of a disease state or as an adverse effect from some medications
hypertensive crisis
also known as malignat hypertension
- Elevated BP that rapidly progresses
- Medical Emergency
- If not treated promptly can result in Kidney Failure, Left Ventricular Heart Failure and Stroke
blood pressure in hypertensive crisis
- Systolic > 200 mm Hg
- Diastolic >150 mm Hg
symtoms of hypertensive crisis
- Morning Headache
- Blurred Vision
- Dyspnea
- Uremia
- Substances normally eliminated in the urine accumulate in blood
prehypertension stage of hypertension
120-139/80-89
high stage of hypertension
Stage 1
140-159/90-99
Stage 2
> 160 / > 100
Essential risk factors for HTN
- Family Hx
- African-American Ethnicity
- Hyperlipidemia
- Smoking
- > 60 Years Old
- Obesity
- Physical Inactivity
- Excessive Na or - Caffeine Intake
secondary risk factors for HTN
- Kidney Disease
- Pregnancy
Medications - Estrogen (Oral Contraceptives) - Glucocorticoids - Methylprednisolone
s/s of htn
- “Silent Killer”
- Headaches
- Dizziness
- Blurred Vision
- Angina
- Fatigue
- Dyspnea
diagnosis of htn
Blood Pressure Readings
- Two or More elevated BP’s on separate days
Use the Correct Cuff
- Too Small – False High
- Too Big – False Low
long term control decrease risk factors for
Stroke
MI
ESKD
Vision Loss
lifestyle changes for htn
- Smoking Cessation
- Weight Reduction - Decrease Na Intake
- Restrict Alcohol consumption
- Increase Exercise
- follow Low-Fat diet
- Decrease Stress
drug therapy changes for htn
- Individualized based on patient
- Often need two or more drugs for adequate control
duiuretics
First drug of choice for managing HTN
Decrease BP by reducing blood volume
diurtetics: potassium-sparing: Spironolcatone
- Prevent reabsorption of Na in exchange for K
- Risk for hyperkalemia
diuretics: loop- furosemide
- Prevent/decrease Na reabsorption and increase water and K excretion
- Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
diuretics: thiazide: hydrochlorothiazide
- Prevent/decrease Na reabsorption and increase water and K excretion
- Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
beta-blockers
- Drug of Choice for patients with Heart Disease
- Decrease BP AND Slow HR by blocking sympathetic nervous system
Common Examples
- Atenolol
- Metoprolol
Beta Blockers: Atenolol & Metoprolol
- Use Caution: Diabetics – May affect glucose production
- Do NOT Administer
HR < 50 bpm
Systolic BP < 90 mm Hg
Calcium Channel Blockers
- In combo with thiazide diuretics first-line therapy for African American patients
- Decrease BP and HR by interfering with movement of calcium through cell membrane
- *Results in vasodilation and blocks sinoatrial (SA) and atrioventricular (AV)node conduction
Common Examples
- Amlodipine
- Diltiazem
Calcium Channel Blockers: Amlodipine& Diltiazem
- Monitor BP/Pulse before Administration
- Use Cautiously: HF Patients
- Avoid Grapefruit juice
ACE inhibitors
- Angiotensin-Converting Enzymes
- Used as single or combination agents
- Decrease BP by preventing conversion of Angiotensin I to Angiotensin II
Preventing Vasoconstriction
Common Examples
- Lisinopril
- Enalapril
ace inhibitors: Lisinopril & Enalapril
- Monitor for S/S of HF
Edema - Report dry cough
Most common side effect
ARBS
- Angiotensin II Receptor Antagonists
- Decreased BP by blocking the vasoconstrictor Angiotensin II at various receptor sites
Common Examples
- Valsartan
- Losartan
ARBS: Valsartan & Losartan
- Use Cautiously: Impaired renal function
- Monitor for Signs of Angioedema
Dyspnea, facial swelling
Home care management
stress compliance- no symptoms dosent mean BP is normal
self management
- Remind Patients suddenly stopping meds can result in rebound HTN
- Monitor and track BP at home
- Educate about Na restriction
- Teach about applicable modifiable risk factors
Health care resources
- The Red Cross
- American Heart Association
Peripheral Arterial Disease (PAD)
affects arteries: blood vessels that carry blood away from the heart
peripheral venous disease
- affects veins: blood vessels that carry blood towards the heart
peripheral arterial disease
- Atherosclerosis – chronic, progressive arterial narrowing
- Results in reduced blood flow, ischemia develops
- Typically affects lower extremities
PAD risk factors
HTN Hyperlipidemia Diabetes Smoking Obesity Sedentary Lifestyle Family Hx Female Sex > 65 Years Old
subjective PAD
Intermittent Claudication
- Burning, cramping pain in legs during exercise
Numbness/burning sensation in feet when in bed
- Pain relief when in dependent position
objective PAD
- Decreased capillary refill
- Decreased/Non-palpable pulses
- Loss of hair on lower calf, ankle, foot
- Dry, scaly, mottled skin= robar
- Thick toenails
- Cold and cyanotic extremity
- Pallor of extremity with elevation
- Rubor (redness) of extremity
Ulcers
- End of Toes or Between Toes
- Pale w/ little granulation
- bad wound flow
6 p’s of arterial disease
Pain Pallor Pulselessness Paresthesia Paralysis- numbness or tingling Poikilothermia (coolness)
interventions of PAD
Promote Vasodilation
- Maintain warm environment, wear socks and avoid cold when possible
- Avoid caffeine and nicotine – cause vasoconstriction
Encourage Appropriate Positioning
- Do NOT cross legs
- Refrain from wearing restrictive garments: no ted stockings
- Cautiously elevate extremities
- Reduces swelling but above heart can cause significant slowing of arterial flow to feet
Medication Therapy
PAD medications
Antiplatelet Medications
- Reduce blood viscosity and decrease clotting mechanisms to increase blood flow
Examples
- Aspirin, Clopidogrel (Plavix)
Monitor s/s of bleeding
May take weeks for effectiveness to be apparent
Statins
- Lower cholesterol, decrease risk for plaque build up
Examples
- Simvastatin
- Atorvastatin
pad surgical management
Balloon Angioplasty
- Balloon dilation with or without stent placement
Atherectomy
- Removal of plaque
Bypass
- Autologous
- Graft
perioheral venous disease patho
Problems with the veins that interfere with adequate return of blood flow from the extremities which results in blood stasis
3 major disorders with pvd
Venous thromboembolism (VTE)
- Clot Formation
- Can break off (Emboli)
Venous Insufficiency
- Skeleton muscle doesn’t contract to help pump blood in veins
Varicose Veins
- Defective (Incompetent) Valves
VTE: cause of venous stasis
Reduced Blood Flow
Dilated Veins
Decreased Muscle Contraction
Faulty Vein Valves
vte: damage to vein lining
IV Catheters, Venipuncture
VTE: what causes increased blood coagulation
Abrupt Stop of Anticoagulant Smoking Oral Contraceptives Estrogen Therapy Hematological Disorders
virchows triange
venous stasis
damage to vein linning
increased blood coagulation
* have to have all 3 to have a vte
subjective cues for PVD
Painful/fullness/heaviness in legs after standing
objective clues for pvd
- Calf or groin pain/tenderness
- Warmth, edema, changes in calf circumference
- Brown discoloration
- Distended visible veins
- Cramping Muscle Aches
- Ulcers @ Ankle
PVD: taking action for a VTE
- Encourage ambulation after anticoagulation therapy initiated
- Warm moist compress
- Do NOT massage affected limb
PVD: taking action for venous insufficiency
- Avoid crossing legs
- Elevate legs for 20min, 4-5/day
- Elevate legs above heart when in bed
PVD meds
anticoagulation
antiplatelet
thrombolytic
pvd meds: anticoagulation
- Prevent or delay coagulation → Preventing clot formation
- Also known as blood thinners
Examples
- Heparin – Monitor PTT
- Lovenox
- Coumadin – Monitor INR
- Eliquis
- Xarelto
pvd meds: antiplatelet
Decrease platelet aggregation → Prevent agglutination →Prevent clot formation
Example
- ASA- asprin
- Plavix
pvd meds thrombolytic
Dissolve or break up existing clots → Open vessel and help prevent future clot formation
Examples
- Heparin
- Lovenox
pvd surgical interventions
Vena Cava Filter
- Filter that traps emboli before it gets to lungs
Vein Stripping
- Removal of large varicosities
