Exam2 Flashcards
Arterial Disease position to alleviate pain
dangling, elevation makes it worse
Venous disease position to alleviate pain
elevation, dangling legs/standing makes it worse
arterial disease explanation of pain
sharp, worse at night
“rest pain”
intermittent claudication-pain from activity
venous disease explanation of pain
heavy, dull throbbing, aching
aterial disease skin of lower extremity
cool to touch
thin/dry/scaly
hairless
thick toe nails
venous disease skin of lower extremities
thick, touch skin
brownish color
arterial disease strength of pulse
very poor/absent
venous disease strength of pulse
present/typically normal
arterial disease, is there edema
not common
venous disease, is there edema
yes-tends to be worse by the end of the day
arterial disease lesions
on feet/ankles
little drainage (no blood flow)
pale/light pink
“punched out” appearance
venous disease lesions
medial parts of lower leg
swollen w/drainage
deep pink/red
irregular edges
shallow
overview of cardiac changes with aging
goes unnoticed
aorta dilation (hyperlipidemia)
stiffening of heart vessels
loss of arterial elasticity
veins thicken & loose elasticity
baroreceptors (tells vessels to constrict) less efficient with age which leads to risk for…
orthostatic hypotension
other age-related changes
-myocardial hypertrophy
-arteriosclerosis (aging)
-atherosclerosis (plague build up)
-thickening of the left ventricular wall
-myocardial musculature less efficient
-decrease in pacemaker cells
True/False: elevation in BP is a normal sign of aging
False
cardiac output formula
Stroke volume (vm) x Heart rate (HR)
afterload
resistance to ejection of blood from the ventricle
contractility is increased by what drugs
digoxin (Lanoxin)
dopamine
dobutamine
catecholamines
contractility is decreased by what drugs
beta-adrenergic blocking agents (metoprolol) [Lopressor]
preload
degree of stretch of the ventricular cardiac muscle fibers at the end of diastole
ejection fraction
% of the end-diastolic blood volume that is ejected with each heartbeat.
-normal left ventricle is 55-65%. lower than 40 requires treatment of HF
1 cause of disability in US
hypertension
hypertension
-arterial walls hypertrophy
-narrow vessels
-unable to support vasodilation
-increase rate of atherosclerosis
-left ventricular hypertrophy (increase risk for CAD)
-damage vessels to all other organs
risk for MI or CVA
what system usually regulates hypertension
renal system
blood pressure is determined by
blood volume, cardiac output, peripheral resistance
papilledema
swelling of the optic nerve
1 sign of hypertensive heart disease
angina/dyspnea (SOB)
goal of hypertension treatment
maintain acceptable BP
ACE inhibitors s/e
cough
CAD (coronary artery disease)
blood is unable to flow through the coronary arteries
CAD can result in
ischemia or infarction
CAD diagnostics
-cardiac stress
-c-reactive protein
-invasive perfusion techniques
CAD management
antiplatelet agents
control chronic diseases
CABG
Coronary Artery Bypass graft surgery
-most common cardiac surgery
-CA are bypassed by the PTs venous or arterial blood vessels
agina
caused by imbalance between O2 supply and demand
women’s unusual angina symptoms
nausea
fatigue
dizziness
Define Heart Failure
decreased contractility of the heart=inability of the heart to pump sufficient blood
cardiac output is
amount of blood pumped out of the left ventricle each minute.
should be 4-8L/min at rest
stroke volume
amount of blood pumped per contraction (65-70mL)
left sided heart failure
-impaired blood to aorta
-causes congestion of blood in pulmonary vessels
-back up in lungs
right sided heart failure
-cannot empty completely
-major cause is Left-sided HF
-peripheral edema
-systemic
LS-HF signs
-pulmonary congestion
-nocturnal dyspnea
-restlessness
-confusion
-tachycardia
-fatigue
-cyanosis
-cool extremities
-S3/S4 heart sounds
RS-HF signs
-fatigue
-ascites
-enlarged liver & spleen
-distended jugular veins
-anorexia/GI distress
-weight gain
-dependent edema
how does human B-type naturetic peptide (BNP) work
excreting NA+ and H2O through vasodilation
BNP 100-300 PG/mL suggestive of HF
management of HF
-reduce heart’s workload & improve cardiac output
-conserve energy
-prevent fatigue
-dietary mod
HF drug therapy
digoxin (inotropic)
toxicity= fatigue, weakness, confusion, anorexia, halos
diuretic therapy
loop& thiazide
vasodilators
ACE inhibitors
HF education
lifestyle changes
control symptoms
monitor for signs
daily weights- 2lbs/day
5lbs/week
signs of MI (heart attack)
-pain radiating down left arm
-mental status change
-agitation
-falls
MI nursing management
-bed rest/limit activity
-assess for chest pain
-permanent smoking cessation
what is meant by afib
several areas in the right atrium initiate impulse resulting in a disorganized, rapid activity of the atria
blood pools and can form clots
implanted pacemaker facts
used for 2nd/3rd degree heart block
battery life= 5-10 yrs
battery power monitored frequently.
hiccupping is a sign of failure
GI changes with aging
-tongue atrophies (decreased taste)
-xerostomia (dry mouth)
-saliva production decreases
-swallowing becomes more difficult
more GI changes
-weakening of esophageal sphincter
-diminished gastric motility (increases risk for indigestion & aspiration)
-decreased elasticity of stomach
-diminished capacity of gastric mucosa to resist damage
last of GI changes
-decreased in intestinal absorption, motility, blood flow
-pancreas decreases in size
-liver size/blood flow decreases
-decreased thirst and hunger drive
-decreased mucosal immune function
most common esophageal disorder in older people
dysphagia- could be indicative of another problem.
oropharyngeal dysphagia
difficulty moving from the mouth into the pharynx (more common with neuro disorders)
esophageal dysphagia
difficulty moving food down the esophagus
Gastroesophageal reflux disease (GERD)
gastric contents flow upward into the esophagus
GERD symptoms
-pyrosis (burning sensation in esophagus)
-dyspepsia (indigestion)
-belching
-sour mouth
-hypersalivation
GERD diagnostics
Barium swallow
upper endoscopy
esophageal manometry
esophageal pH monitoring
GERD treatments
antacids
H2 antagonists (decrease production of acid)
PPI (decrease release, can increase risk for bone issues)
Gastritis
men/women equal effected
inflammation or stomach lining
erosive vs non
non erosive gastritis
H. pylori
Peptic Ulcer Disease s/s
dull/gnawing/burning pain in back
heartburn
nausea
vomiting
constipation
diarrhea
bleeding
gastric vs duodenal PUD
Gastric
-pain after eating
dudenal
-pain 2-3 hrs after eating, increases at night
diverticular diease
saclike mucosal projections- trap feces-> infection/inflammation. greater risk in men
Risk Factors: obesity
chronic constipation
hernia
atrophy or intestinal wall
diverticular disease s/s
pain (LLQ)
nausea/vomiting
constipation
diarrhea
low grade fever
blood/mucous in stool
foods to avoid with diverticulitis
corn, popcorn, nuts, strawberries, foods containing seeds
what is a small bowel obstruction
blockage that prevents the contents of the intestines from passing normally through the digestive tract
common causes: adhesions, hernia, tumors
Nursing mgmt for bowel obstruction
NG tube- decompress the stomach, allow the bowel to rest
lower intermittent sucking
checking placement
admin meds
chronic constipation defined as
two or fewer stools per week
nutrition in aging
-decrease in needed calories
-decrease in body fluids
2/7L/day men
3.7L/day women
BMI measurement
<22 undernutrition (higher mortality)
>25 overweight (risk for morbidity)
osteoblasts
bone forming
osteocytes
maintaining bone
osteoclasts
bone cells that reabsorb bone during repair and growth
changes of aging musculoskeletal Type 1
menopausal bone loss. 5-10 yrs after menopause
changes of aging musculoskeletal Type 2
senescent bone loss-affects both sexes
musculoskeletal changes
-bones become stiff, weak, brittle and porous
-lose 1-2cm every 2 decades in ht
-erosion of hyaline cartilage
-vitamin D
which extremities atrophy earlier
lower
sarcopenia is
a loss of muscle tissue as a natural part of the aging process
leading cause of accidental death
falls. 1:3 people >65 sustain serious fall
exercise benefits: weight bearing, balance, swimming
wt bearing- bones
balance- falls
swimming- joints
osteoarthritis vs rheumatoid arthritis to do with inflammation
OA isn’t inflammatory
RA is inflammatory disease
