HTN, PVD, PAD Flashcards
The largest artery in the body
Aortic artery
Factors that affect blood pressure
Peripheral resistance, vessel elasticity, blood volume, cardiac output
The volume of blood pumped by each side (ventricle) of the heart in one minute
Cardiac output
Resistance of blood vessels to blood flow
Peripheral resistance
The total amount of blood in the circulatory system
Blood volume
Components of the blood
Nutrients and oxygen
Decreased blood volume causes __________, while elevated blood volume causes _________
Dehydration & hypotension; hypertension
Peripheral vascular disease (PVD) most commonly affects the
Extremities; particularly the lower extremities
Volume of blood pumped by each ventricle in one contraction (heartbeat)
Stroke volume (SV)
How much blood is pumped out of the left ventricle with each heartbeat?
~ 70 mL
Typical heart rate
75 bpm
Ways to increase cardiac output
Increase SV, increase HR, or increase both
Cardiac output equation
CO = SV x HR
Blood pressure equation
Blood pressure (P) = Cardiac output (Q) x vascular resistance (R)
Which two factors are interconnected through the hemodynamic regulation of blood pressure?
Cardiac output and hypertension
Hypertension that is developed over time
Primary or essential
Risk factors for primary/essential hypertension
Genetics, smoking, obesity, high salt intake, high alcohol consumption, stress, lack of exercise, aging
Hypertension that occurs quickly and more severely
Secondary
risk factors for secondary hypertension
Obstructive sleep apnea, heart defects, kidney disease, medications or illegal drugs, adrenal/thyroid conditions
Hormone that is released when the body senses that BP and/or blood volume is low
Renin
Renin triggers
Angiotensin
Angiotensin signals __________ to retain sodium and water when BP is low, or release sodium and water when BP is high
Aldosterone
Electrolyte imbalance associated with ACE inhibitors
Hyperkalemia (release of sodium and water, retention of potassium)
Cardiac complications of HTN
Coronary artery disease —> angina or MI, left ventricular hypertrophy, HF
Brain complications of HTN
TIA, stroke, cognitive impairment, vascular dementia
Kidney complications of HTN
Chronic kidney disease (CKD), end-stage renal disease (ESRD)
Eye complications of HTN
Hypertensive retinopathy —> damage to retinal blood vessels, vision impairment, blindness
Blood vessel complications of HTN
Atherosclerosis, PAD, increased risk of aneurysms and vascular complications
Nervous system complications of HTN
Peripheral neuropathy (particularly in individuals with poorly controlled HTN)
Atherosclerosis/PVD/PAD risk factors
Aging, genetics, gender, hyperlipidemia, HTN, smoking, DM, lack of exercise, stress, obesity
Chronic inflammatory disorder that causes build up of cholesterol plaques on medium and large arteries
Atherosclerosis
Loss of arterial elasticity through the hardening and thickening of arterial walls
Arteriosclerosis
Most common cause of PAD
Atherosclerosis
Most common arteries affected by atherosclerosis
Abdominal aorta, coronary, popliteal, carotid
PAD pathophysiology
Hardening of fatty deposits in arteries narrow the opening and block effective blood flow
An umbrella term for disorders affecting blood vessels outside the heart and brain
Peripheral vascular disease (PVD)
A specific type of PVD where plaque buildup occurs in arteries carrying blood to extremities, especially the legs
Peripheral artery disease (PAD)
S/S of PVD
Pain or discomfort in legs, cramping, numbness, weakness, skin color/temp changes
S/S of PAD
Intermittent claudication, cold feet, reduced hair growth on legs
PAD can progress to
Critical limb ischemia
Diagnosis for PVD and PAD
Medical history, physical, and imaging tests such as ultrasound and angiography
PVD/PAD treatment
Lifestyle changes, medications (to control risk factors), possible procedures such as angioplasty and surgery
First diagnostic test for PAD
Ankle brachial index (ABI) test
Recommendation for mild to moderate PAD
Lifestyle modifications
Normal/no PAD as determined by ABI
> 0.9
Mild PAD as determined by ABI
0.8-0.9
Moderate PAD as determined by ABI
0.3-0.7
Critical PAD as determined by ABI
<0.3
A arterial condition affecting blood flow to certain parts of the body, often fingers and toes
Raynaud’s Disease
Rare disease affecting small and medium sized arteries and veins in the arms and legs
Buerger’s Disease
Cause of Raynaud’s
Cold or stress triggers episodes, causing small artery narrowing
Cause of Buerger’s
Strongly associated with tobacco use
S/S of Raynaud’s
Episodic color changes (white, blue, red), numbness, tingling during episodes
S/S of Buerger’s
Pain, tenderness, skin changes, ulcers, potential progression to gangrene
Age and gender risk factors for Raynaud’s
Can affect anyone, more common in women and people in colder climates
Age and gender risk factors for Buerger’s
Affects young males more
Raynaud’s management
Lifestyle changes, avoiding triggers, medications
Buerger’s management
Smoking cessation, medications for vasodilation, surgical interventions (severe cases)
Raynaud’s prognosis
Generally manageable with lifestyle changes and medications
Buerger’s management
Severity can lead to amputation; smoking cessation critical!!
Arterial narrowing or occlusion (arteriosclerosis) which causes decreased O2 and nutrients to the lower extremities
PAD
Pooling of blood in the extremities due to the inability to bring blood back to the heart (vascular insufficiency)
Peripheral venous disease
S/S of PAD
1) Sharp pain, 2) absent pulse, 3) skin: cool to touch, pale, shiny, absent hair, thin, dry, scaly, no edema, 4) Lesions: red sores on toes and feet with punched out appearance, 5) gangrene (death of tissues)
S/S of peripheral venous disease
1) dull, achy pain, 2) presence of strong pulse, 3) skin: edema, warm legs, yellow/brown ankles, 4) irregular shaped sores/lesions, 5) no gangrene
Patient positioning for PAD
Hang/dangle the patients legs (remember: an “A” shape for PAD)
Patient positioning for peripheral venous disease
Elevate patients legs (remember: v shape for PVD)
Pathogenesis of PAD
Endothelial dysfunction (impairment of arterial lining d/t HTN or DM), inflammatory response, plaque formation, plaque rupture (risk for clot formation), ischemia and tissue damage, thrombosis and embolism, collateralization
Attempted compensation by developing new blood vessels
Collateralization
PAD lifestyle modifications
Healthier diet, smoking cessation, exercise, lose weight
Anti-platelet agents to reduce the risk of blood clots in PAD
Aspirin, clopidogrel (Plavix)
Cholesterol lowering agents to control and slow progression of atherosclerosis in PAD
-statins (atorvastatin)
PAD medications to reduce cardiovascular risk
Antihypertensives
PAD medication for improving claudication symptoms and walking distance
Cilostazol
Pain management medications for PAD
Acetaminophen or NSAIDs
PAD endovascular surgical intervention used to dilate narrowed arteries and improve blood flow
Ballon angioplasty
PAD endovascular surgical intervention that provides structural support to the treated artery and prevents re-narrowing
Stent placement
PAD endovascular surgical intervention that removes plaque from arterial walls
Atherectomy
PAD surgical revascularization that reroutes blood flow around blocked arteries, using autologous grafts or synthetic material
Bypass surgery
PAD surgical revascularization that removes atherosclerotic plaque from the inner lining of the artery to restore blood flow
Endarterectomy
PAD surgical intervention for severe cases with tissue necrosis or non-healing ulcers
Amputation
Nursing assessment for PAD
Vascular assessment — peripheral pulses, skin color, temperature, capillary refill time; assess for pain, claudication, and ulceration
PAD patient education regarding foot care
Regular inspection and moisturization
PAD nursing wound care
Cleaning, debridement, dressing changes, monitor for s/s of infection
How to correctly take BP
Choose correct cuff size for patient’s arm circumference, support arm at heart level with cuff at the same level as the heart, take multiple readings and use an average for accuracy
Factors that can cause an elevated blood pressure reading
Not allowing the patient to rest for at least 5 minutes before measurement, speaking or moving during the measurement
At what rate should the nurse deflate the cuff when measuring blood pressure?
2-3 mmHg per second
Elevated blood pressure due to anxiety in a medical setting
White coat hypertension
How to prevent inaccurate BP measurements in a patient with A.fib or irregular heartbeat
Use automated monitors that account for irregular heart rhythms or average multiple measurements
Improving blood flow to tissues and organs
Revascularization
Procedure commonly performed on carotid arteries to reduce stroke risk
Endarterectomy
Surgical removal of blood clot and atherosclerotic material to restore blood flow, typically performed in cases of acute arterial occlusion
Thromboendarterectomy
Patient education for warfarin (Coumadin)
Regular blood work, goal INR: 2.5 (2.0-3.0), s/s of toxicity include easy bruising and bleeding
First sign of sepsis
Tachycardia
Sepsis interventions
Establish IV access (18 gauge), fluid resuscitation, antibiotics