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Med Surg 1 > Care of Pt. with vascular problems > Flashcards

Care of Pt. with vascular problems Flashcards

1
Q

hypertension

what can it lead to?

A
  • High Blood Pressure (BP)

- Can lead to Stroke, MI, Kidney Failure, Death

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2
Q

AHA recommendations for hypertension

A

Maintain BP less than 130/80

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3
Q

JNC Recommendations

for hypertension

A

Over 60
- Maintain BP less than 150/90
Under 60
- Maintain BP less than 140/90

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4
Q

Arterial baroreceptor system

A
  • Receptors located primarily in the carotid sinus, aorta, and left ventricle
  • Alter HR, Vasoconstrict and Vasodilate
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5
Q

Regulation of body fluid volume

A
  • Excess fluid – Rise in Cardiac Output → Increased BP

- Fluid Deficit – Decrease in Cardiac Output → Decreased BP

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6
Q

Renin-angiotensin-aldosterone system

A
  • 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
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7
Q

Vascular autoregulation

A

Ability of organ to maintain blood flow despite changes in BP

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8
Q

essential hypertension

& risk factors

A
  • 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

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9
Q

secondary hypertension

A

Occurs as a result of a disease state or as an adverse effect from some medications

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10
Q

hypertensive crisis

A

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
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11
Q

blood pressure in hypertensive crisis

A
  • Systolic > 200 mm Hg

- Diastolic >150 mm Hg

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12
Q

symtoms of hypertensive crisis

A
  • Morning Headache
  • Blurred Vision
  • Dyspnea
  • Uremia
  • Substances normally eliminated in the urine accumulate in blood
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13
Q

prehypertension stage of hypertension

A

120-139/80-89

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14
Q

high stage of hypertension

A

Stage 1
140-159/90-99

Stage 2
> 160 / > 100

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15
Q

Essential risk factors for HTN

A
  • Family Hx
  • African-American Ethnicity
  • Hyperlipidemia
  • Smoking
  • > 60 Years Old
  • Obesity
  • Physical Inactivity
  • Excessive Na or - Caffeine Intake
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16
Q

secondary risk factors for HTN

A
  • Kidney Disease
  • Pregnancy
Medications
- Estrogen (Oral
Contraceptives)
- Glucocorticoids
- Methylprednisolone
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17
Q

s/s of htn

A
  • “Silent Killer”
  • Headaches
  • Dizziness
  • Blurred Vision
  • Angina
  • Fatigue
  • Dyspnea
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18
Q

diagnosis of htn

A

Blood Pressure Readings
- Two or More elevated BP’s on separate days

Use the Correct Cuff

  • Too Small – False High
  • Too Big – False Low
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19
Q

long term control decrease risk factors for

A

Stroke
MI
ESKD
Vision Loss

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20
Q

lifestyle changes for htn

A
  • Smoking Cessation
  • Weight Reduction - Decrease Na Intake
  • Restrict Alcohol consumption
  • Increase Exercise
  • follow Low-Fat diet
  • Decrease Stress
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21
Q

drug therapy changes for htn

A
  • Individualized based on patient

- Often need two or more drugs for adequate control

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22
Q

duiuretics

A

First drug of choice for managing HTN

Decrease BP by reducing blood volume

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23
Q

diurtetics: potassium-sparing: Spironolcatone

A
  • Prevent reabsorption of Na in exchange for K

- Risk for hyperkalemia

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24
Q

diuretics: loop- furosemide

A
  • Prevent/decrease Na reabsorption and increase water and K excretion
  • Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
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25
Q

diuretics: thiazide: hydrochlorothiazide

A
  • Prevent/decrease Na reabsorption and increase water and K excretion
  • Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
26
Q

beta-blockers

A
  • Drug of Choice for patients with Heart Disease
  • Decrease BP AND Slow HR by blocking sympathetic nervous system

Common Examples

  • Atenolol
  • Metoprolol
27
Q

Beta Blockers: Atenolol & Metoprolol

A
  • Use Caution: Diabetics – May affect glucose production
  • Do NOT Administer
    HR < 50 bpm
    Systolic BP < 90 mm Hg
28
Q

Calcium Channel Blockers

A
  • 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
29
Q

Calcium Channel Blockers: Amlodipine& Diltiazem

A
  • Monitor BP/Pulse before Administration
  • Use Cautiously: HF Patients
  • Avoid Grapefruit juice
30
Q

ACE inhibitors

A
  • 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
31
Q

ace inhibitors: Lisinopril & Enalapril

A
  • Monitor for S/S of HF
    Edema
  • Report dry cough
    Most common side effect
32
Q

ARBS

A
  • Angiotensin II Receptor Antagonists
  • Decreased BP by blocking the vasoconstrictor Angiotensin II at various receptor sites

Common Examples

  • Valsartan
  • Losartan
33
Q

ARBS: Valsartan & Losartan

A
  • Use Cautiously: Impaired renal function
  • Monitor for Signs of Angioedema
    Dyspnea, facial swelling
34
Q

Home care management

A

stress compliance- no symptoms dosent mean BP is normal

35
Q

self management

A
  • 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
36
Q

Health care resources

A
  • The Red Cross

- American Heart Association

37
Q

Peripheral Arterial Disease (PAD)

A

affects arteries: blood vessels that carry blood away from the heart

38
Q

peripheral venous disease

A
  • affects veins: blood vessels that carry blood towards the heart
39
Q

peripheral arterial disease

A
  • Atherosclerosis – chronic, progressive arterial narrowing
  • Results in reduced blood flow, ischemia develops
  • Typically affects lower extremities
40
Q

PAD risk factors

A 
HTN
Hyperlipidemia
Diabetes
Smoking
Obesity
Sedentary Lifestyle
Family Hx
Female Sex
> 65 Years Old
41
Q

subjective PAD

A

Intermittent Claudication
- Burning, cramping pain in legs during exercise

Numbness/burning sensation in feet when in bed
- Pain relief when in dependent position

42
Q

objective PAD

A
  • 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
43
Q

6 p’s of arterial disease

A 
Pain
Pallor
Pulselessness
Paresthesia
Paralysis- numbness or tingling
Poikilothermia (coolness)
44
Q

interventions of PAD

A

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

45
Q

PAD medications

A

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
46
Q

pad surgical management

A

Balloon Angioplasty
- Balloon dilation with or without stent placement

Atherectomy
- Removal of plaque

Bypass

  • Autologous
  • Graft
47
Q

perioheral venous disease patho

A

Problems with the veins that interfere with adequate return of blood flow from the extremities which results in blood stasis

48
Q

3 major disorders with pvd

A

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

49
Q

VTE: cause of venous stasis

A

Reduced Blood Flow
Dilated Veins
Decreased Muscle Contraction
Faulty Vein Valves

50
Q

vte: damage to vein lining

A

IV Catheters, Venipuncture

51
Q

VTE: what causes increased blood coagulation

A 
Abrupt Stop of Anticoagulant
Smoking
Oral Contraceptives
Estrogen Therapy 
Hematological Disorders
52
Q

virchows triange

A

venous stasis
damage to vein linning
increased blood coagulation
* have to have all 3 to have a vte

53
Q

subjective cues for PVD

A

Painful/fullness/heaviness in legs after standing

54
Q

objective clues for pvd

A
  • Calf or groin pain/tenderness
  • Warmth, edema, changes in calf circumference
  • Brown discoloration
  • Distended visible veins
  • Cramping Muscle Aches
  • Ulcers @ Ankle
55
Q

PVD: taking action for a VTE

A
  • Encourage ambulation after anticoagulation therapy initiated
  • Warm moist compress
  • Do NOT massage affected limb
56
Q

PVD: taking action for venous insufficiency

A
  • Avoid crossing legs
  • Elevate legs for 20min, 4-5/day
  • Elevate legs above heart when in bed
57
Q

PVD meds

A

anticoagulation
antiplatelet
thrombolytic

58
Q

pvd meds: anticoagulation

A
  • Prevent or delay coagulation → Preventing clot formation
  • Also known as blood thinners

Examples

  • Heparin – Monitor PTT
  • Lovenox
  • Coumadin – Monitor INR
  • Eliquis
  • Xarelto
59
Q

pvd meds: antiplatelet

A

Decrease platelet aggregation → Prevent agglutination →Prevent clot formation

Example

  • ASA- asprin
  • Plavix
60
Q

pvd meds thrombolytic

A

Dissolve or break up existing clots → Open vessel and help prevent future clot formation

Examples

  • Heparin
  • Lovenox
61
Q

pvd surgical interventions

A

Vena Cava Filter
- Filter that traps emboli before it gets to lungs

Vein Stripping
- Removal of large varicosities

Med Surg 1 (25 decks)

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