Chapter 38 Vascular Problems Flashcards
Drug Classes for HTN Management
Thiazide (low ceiling) diuretics: HCTZ
Loop (high ceiling) diuretics: Furosemide (lasix)
Potassium Sparing diuretics: Spironolactone (aldactone)
Calcium channel blockers: Verapamil hydrochloride (Calan), Amlodipine (Norvasc)
Beta adrenergic blockers (cardioselective and noncardioselective)
ACE inhibitors: Captopril (Capoten), Enalapril (Vasotec)
ARBs: Candesartan (Atacand) and Losartan (Cozaar)
Aldosterone Receptor Antagonists: Eplerenone (Inspra)
Emergency Care of HTN Crisis
Assess: severe h/a, extremely high BP, dizziness, blurred vision, disorientation
Intervene: place pt in semi fowlers
administer O2
administer Nitroprusside, Nicardipine, or other infusion drug as prescribed. cover infusion bag of nitroprusside to prevent breakdown by light.
monitor BP every 5-15min. until diastolic is below 90 and not less than 75. then monitor q30min.
observe for neurologic and cardiovascular complications: seizures, numbness, weakness, tingling extremities, dysrhthmias or chest pain.
Key Features of Chronic PAD Stage 1: Asymptomatic
no claudication
bruit or aneurysm may be present
pedal pulses decreased or absent
Key Features Chronic PAD Stage 2: Claudication
muscle pain, cramping or burning with exercise and relieved with rest
symptoms are reproducible with exercise
Key Features Chronic PAD Stage 3: Rest Pain
pain while resting commonly awakens pt at night
pain is described as numbness, burning, toothache type pain
pain is in distal portion of extremity (toes, arch, forefoot, heel) rarely in calf or ankle
pain is relieved by placing extremity in dependent position
Key Features Chronic PAD Stage 4: Necrosis/Gangrene
ulcers and blackened tissue occur on toes, forefoot and heel
distinctive gangrenous odor is present
Key Features Arterial Ulcers: HX, location/appearance, other assessment findings, TX
Pt. reports claudication after walking 1-2 blocks
rest pain usually present
pain at ulcer site
two or three risk factors present
end of toes, between toes, deep, ulcer bed pale with even edges, little granulation tissue
cold or cold foot, decreased or absent pulses, atrophy of skin, hair loss, pallor with elevation, dependent rubor, possible gangrene, when acute-neurologic deficits noted
treat underlying cause (surgical, revascularization) prevent trauma and infection, pt education, stressing foot care
Key Features Venous Ulcers: HX, location/appearance, other assessment findings, TX
chronic nonhealing ulcer
no claudication or rest pain
moderate ulcer discomfort
pt reports ankle or leg swelling
ankle area, brown pigmentation, ulcer bed pink, usually superficial with uneven edges, granulation tissue present
ankle discoloration and edema, full veins when leg slightly dependent, no neurologic deficit, pulses present, may have scarring from previous ulcers
long term wound care (Unna boot, damp to dry dressing), elevate extremity, pt education, prevent infection
Key Features Diabetic Ulcers: HX, location/appearance, other assessment findings, TX
diabetes
peripheral neuropathy
no reports of claudication
plantar area of foot, metatarsal heads, pressure points on feet, deep, pale with even edges, little granulation tissue
pulses usually present, cool or warm foot, painless
rule out major arterial disease, control diabetes, pt education regarding foot care, prevent infection
Home Care PVD
ASSESS tissue perfusion: distal circulation, sensation, motion, presence of pain, pallor, paresthesia, pulselessness, paralysis, poikilothermia (coolness), ankle brachial index
ASSESS adherence to therapeutic regimen: foot care instructions, quitting smoking, dietary restrictions, exercise, avoiding exposure to cold and constrictive clothing
ASSESS ability to manage wound care and prevent further injury: compression stockings, compression pumps, use of various dressing materials, S&S to report to nurse
ASSESS coping ability
ASSESS home environment: safety hazards, esp. r/t falls
Foot care for pt. with PVD
Keep feet clean with mild soap in room temp water
Keep feet dry esp. Ankles and between toes
Avoid injury to ankles and feet. Wear comfortable shoes, never go without shoes.
Keep toenails clean and filed. Cut straight across.
Apply lubricating lotion to feet to avoid cracked skin
Prevent exposure to extreme heat or cold. Never use heating pad
Avoid constricting garments
See podiatrist or physician if problems
Avoid extended pressure to feet or ankles, like when leaning on something
Care of Pt. Receiving Anticoagulant Therapy
Re check dosage before administration
monitor: hematuria, frank or occult blood in stool, ecchymosis, petechiae, AMS (cranial bleed), pain(esp. abd pain).
V/S for dec. BP and inc. pulse
Antidotes available (protamine sulfate: heparin, K: warfarin).
Monitor aPTT for unfractionized heparin or INR for warfarin or LMWH.
Apply prolonged pressure over venipuncture sites.
SubQ heparin, apply pressure, no massage
Use only electric razor, do not use hammers or saws, report signs of bleeding, nosebleeds, ecchymosis, AMS, take drugs at precise time, do not stop taking drug abruptly.
Foods/Drugs that Interfere with Warfarin (Coumadin)
Eat (for vit. K): broccoli, cauliflower, spinach, kale, green leafy vegetables, brussel sprouts, cabbage, liver
Avoid: allopurinol, NSAIDs, acetaminophen, Vit E, histamine blockers, cholesterol reducing drugs, antibiotics, birth control pills, antidepressants, thyroid drugs, antifungal infections, other anticoagulants, corticosteroids, herbs: St. John’s wort, garlic, ginseng, Ginko biloba
Pt. Education for Venous Insufficiency
Elastic Stockings: wear during day and evening, put on upon awakening and before getting out of bed, do not bunch up and apply like socks. place hands inside and pull out heel. place foot over your foot and slide the rest up. rough seams on outside, not next to skin. do not push down for comfort, may function like tourniquet, put on clean stockings each day. wash by hand in gentle detergent and warm water, if stretched out, replace.
DO’s and DON’Ts: elevate legs for 20mins four or five times/day. elevate legs to level of heart in bed. avoid prolonged sitting or standing. do not cross legs. crossing ankles is acceptable for short periods. do not wear tight restrictive pants. avoid garters and girdles.
Risk Factors for Atherosclerosis
Low HDL High LDL increased Triglycerides genetic predisposition DM obesity sedentary lifestyle smoking stress African American or Hispanic
