Medsurg Exam 1: Vascular Disease + Endocarditis Flashcards
Vascular Diseases
Diseases of the vasculature
Arteriosclerosis
thickening of the arterial wall
Atherosclerosis
(a type of arteriosclerosis )
Prevention is the goal
healthy BP, physical exercise, weight reduction, DASH Diet which emphasizes vegetables, fruits, whole grains, eat low fat diary, poultry, fish, legumes
DASH Diet
Dietary approaches to stop HTN
Emphasize vegetables, fruits whole grains
Eat low fat diary, poultry, fish, legumes, non tropical vegetable oils and nuts
Limit sweets, sugar sweetened beverages red meats
Causes of Atherosclerosis
HTN
Coronary artery disease
Cerebrovascular disease
Peripheral artery disease
contributing factors of Atherosclerosis
age, smoking, high lipid levels
Interventions for Atherosclerosis
May place a stent
Balloon percutaneous transluminal angioplasty (PTA)
Rotational Atherectomy
Bypass revascularization
Medications for Atherosclerosis
Medications to decrease platelet aggregation = aspirin and clopidogrel
Lipid and cholesterol lowering agent = want to raise HDLS, lower LDLS, lower TGs
Statins = lovastatin and numerous others (NO grapefruit with these)
Bile acid sequestrants
Nicotinic acid
Fibric acids
PAD/PVD
Slow progressive disorders of circulation
Can involve arteries, veins, or lymphatics
Result of systemic atherosclerosis
Changes the flow → cant get adequate flow to tissues as result
Inflow versus outflow
Inflow not as much significant damage
Outflow is when you start to see more significant damage
Findings with PAD
Intermittent claudication Pain, numbness, aching, heaviness of the muscle Weak or absent distal pulses distally Decreased hair on legs and toes Poor nail growth Decreased temperature in one leg Wounds that do not heal well Erectile dysfunction
acute limb ischemia
sudden decrease in blood flow to an extremity often due to embolism especially from heart s/p MI or atrial fibrillation = I MMEDIATE INTERVENTION
Heparin therapy and medications can be ordered
Surgical thrombectomy
Severe pain or rapid onset → Six Ps
What are the 6 p’s
Pain, pallor, pulselessness, paresthesias, paralysis, poikilothermia
Risk Factors of DVT
Prolonged sitting
Bed rest
Dehydration
Post partum (6 months) = due to hypercoagulability after giving birth
Use of estrogens/ bc pills = in the past due to heavy dose estrogens
pelvic/ hip surgery
Trauma
DVT Manifestations
Leg pain unilaterally = see it on one side typically
Swelling extremity
Low grade fever
Homan’s sign (not diagnostic) = pressing on the foot back towards the leg and if there is pain = does not rule it in and does not rule it out
Diagnosis of DVT
clinical presentation, history, and doppler ultrasound → the best thing to do is prevention → Lovenox sq or heparin sq (safe), hydration and moving asap
Acute Treatment = bedrest and anticoagulation
Heparin IV bolus followed by heparin IV drip
Coumadin po after Heparin IV drip
Chronic Treatment of DVT
greenfield filter (surgery) = significant risk of pulmonary embolism Prevention is the best course of action = thinking how to do in the hospital
What is endocarditis?
Inflammation of the inner lining of heart
Usually infectious process (bacterial endocarditis, not always infection (can be fungal virus ect)
Papillary muscles, chordae tendineae, valves can be involved
Sterile variety seen in cancer pts = inflammation, but no infections
Mortality rate %25 rate - even if we do everything right
What are risk factors of endocarditis?
any port to entry of blood stream , Drug users, Central Line, Previous valvular surgery, Congential heart defect, systemic infection from any source (urosepsis), IV placement (poor technique), Skin rashes, lesions, abscess, dental work (mouth is extremely vascular)
s/s of endocarditis?
Fatigue
Fever = all infections
Murmur (systolic murmurs because of regurgitations)
Paleness
Red, painless spots on the palms and soles (Janeway lesions - more common in peds)
SOB with activity
Swelling of the feet, legs, abdomen (heart failure)
Weakness
Weight loss ~ Anorexia
Embolic complications = vegetation can break from leaflets and travel anywhere (Brain, kidneys, spleen = more infection)
With Heart Failure Symptoms = weight gain
3 Goals of Endocarditis?
DESTROY the infection
Repair or Replace the valves if needed (this is a goal, but not while person is infected)
Treat complications
Diagnosis of Endocarditis
Clinical examination (New murmur (pain attention), fever, signs of heart failure) Blood cultures are positive = generally more than one set and from more than one site Positive - infection CBC = WBC is high CXR = chest X-tray, = pulmonary edema, cardiomegaly Echocardiogram = verifies evidence of damage to the valves
Treatment of Endocarditis
Rest in bed until improved
Nursing care: like that for heart failure patients (O2)
Long term IV antibiotics = 4-8 weeks (IV around the block, may be more than one)
Valve replacement may be necessary = replacement of fixing, once infection is good
Heart failure is secondary to endocarditis
