CCRN HTN Crisis, Valves, PAD, CAD

Question 1

HTN Dx?

Answer 1

Dx: Critically elevated BP w/ end stage organ damage.

Question 2

HTN Crisis Presentation? dBP level greater than? (5)

Answer 2

Presents w/: AMS, seizures, vomiting, visual disturbances, headache, dBP>120mmHg, epitaxis. Think what occurs with extreme vasoconstriction.

Question 3

HTN Crisis Risk Factors? (7)

Answer 3

Risk factors: DM, smoking, obesity, HTN, PO contraceptives, HLD

Question 4

HTN Crisis Causes: (2)

Answer 4

Causes: 1. Uncontrolled HTN 2. Renal dysfunc/endocrine disorder

Question 5

Why is it so dangerous?

Answer 5

HTN enhances sympathetic stimulation, causes systemic vascular vasoconstriction. This decreases blood flow to vital organs. STROKE

Question 6

HTN Crisis Treatments (3)

Answer 6

1. Nitroprusside: WATCH for cyanide toxicity secondary to thiocyanate. Watch for AMS. Can cause fetal renal impairment.
2. Labetalol: long acting IV beta blocker, preferred w/ CAD
3. Fenoldopam mesylate (Corlopam) long half life and hypokalemic effect though

Question 7

Describes what occurs to the valves during S1 phase

Answer 7

1. Systolic ejection phase
   The ventricles are squeezing, and the semilunar valves (aortic and pulmonic) are open. The AV valves (mitral and tricuspid) are close, resuming in S1 (Lub)

Question 8

Describes what occurs to the valves during S2 phase

Answer 8

1. Diastolic filling phase
   The ventricles are relaxed, allowing refill to occur. So AV Valves are open. Semilunar valves are closed (aortic and pulmonic). This results in a dub. This phase is longer since it’s the filling phase.

Question 9

What are S3 sounds associated with?

Describe the sound

Answer 9

Phase S1, S2, S3. KEN-TU-KEE. whole note-halfpause-halfnote-half note

Associated with high left ventricular pressure and heart failure. “ventricular gallop”

Question 10

What are S4 sounds associated with?

Describe the sound

Heard in a fib?

Answer 10

Associated with HTN, MI, infarction and aortic stenosis. “atrial gallop”

S4, S1, S2. half note half note half pause whole note
TEN-NE-SSEE

No heard in a fib cuz there’s no atrial contraction

Question 11

Acute PAD S/S? (5)

Answer 11

Pain, Pallor, Paresthesia, Pulselessness, Paralysis

Question 12

PAD Testing? (2)

Answer 12

Ankle-Brachial Index

Question 13

PAD Tx (3)

Answer 13

Positional: Bedrest in reverse Trendelenburg
Do not elevate affected extremity cuz it’s decrease perfusion
Mech: Embolectromy, bypass graft, angioplasty
Pharm: A/C,Antiplatelets, Vasodilators, thrombolytic

Question 14

S/S of Carotid Artery Disease? (4)

Answer 14

TIA, Monocular Visual disturbances, Aphasia, Stroke

Question 15

Testing of Carotid Artery Disease? (4)

Answer 15

Angiography (gold standard), Carotid U/S, MRA, CTA

Question 16

Carotid Artery Disease Tx? (4)

Answer 16

Carotid endarterectomy (CEA), Carotid Stending, Asa, statins

Question 17

Assessments for post procedure stenting/CEA for carotid artery disease?

Answer 17

• frequent neuro checks
• BP monitoring for low or high, labile bp, bradycardia, bleeding
• hyperperfusion syndrome

Question 18

What is hyper perfusion syndrome? (r/t Carotid artery disease)

Answer 18

headache ipsilateral to revascularized internal carotid artery, focal motor seizures, intracerebral hemorrhage