Midterm Flashcards
what is blood pressure
force exerted by circulating blood on the walls of blood vessels
systolic blood pressure
blood pressure when the heart (ventricles) is contracting in a BP reading
diastolic blood pressure
the time when the heart is in a period of relaxation and dialation
stroke volume
amount of blood ejected into the aorta with each heartbeat
heart rate
of heart beats per minute
peripheral resistance
the resistance factors in the circulatory systems that affects the ease of blood flow
- tone of BVs
- viscosity of blood
- increase in peripheral resistance = increase in cardiac output and vice versa
normal BP
120/80
hypotension
90 or less/60 or less
pre hypertension
130-139/85-89
stage 1 hypertension (mild)
140-159/90-99
stage 2 hypertension (moderate)
160-179/100-109
stage 3 hypertension (severe)
180-209/110-119
stage 4 hypertension (very severe)
210+/120+
pulse pressure
the difference between the systolic and diastolic pressures. Palpated as a rhythmical throbbing over an artery, normally assessed at the wrist or neck
when taking BP, which artery is the stethoscope on
brachial artery
false high BP reading causes
- Narrow cuff size
- Wrapping cuff loosely or unevenly
- Recording BP immediately after a meal, cigarette, exercise or if bladder is full
- Deflating cuff too slowly
- “White coat” syndrome- fear of doctors
false low reading
- Having a person’s arm above their heart
- Diminished hearing of health professional
false high or low reading
- defective equipment
- Performing the technique too quickly or without attention to detail
baroreceptors and location
- Receptors within BV walls that sense pressure changes.
- Locations: Carotid sinus - in the neck at the point where the carotid of the aorta, large veins, pulmonary BV and the heart
chemoreceptors and location
- Monitor the concentration of O2, CO₂ and H in the blood Located in the carotid sinus and the heart
- Influence breathing rate
- May change vascular tone through communication with the vasomotor centers of the brain
how does the autonomic nervous system affect BF
- Short term influences on BP- HR and peripheral resistance
- Parasympathetic stimulates the vagus nerve decreasing HR Sympathetic stimulation increases BP
how does the central nervous system affect blood flow
Prevents ischemia of brain tissue in extreme cases of insufficient causing massive vasoconstriction to raise BP
Renin-Angiotensin-Aldosterone mechanism
- Utilize salt retention or excretion to influence BP
- Renin, a kidney enzyme, released with sympathetic NS firing causes vasoconstriction, salt and water retention, invreasing BP
how do hormones affect blood flow
Influence vasoconstriction
- ex. Renal prostaglandins & vasopressin
Renal body-fluid pressure
Maintains BP over long term via water and salt excretion through the kidneys.
hypertension
elevation of blood pressure above normal for a prolonged period of time
hypertension is diagnosed if
systolic pressure is 140+ and diastolic is 90+ for 2-3 consecutive visits
target hypertension organs
heart
kidneys
CNS
arteries
how is the heart affected by hypertension
angina pectoris
acute myocardial infarction
acute pulmonary edema
congestive heart failure
how are the kidneys affected by hypertension
atherosclerosis plaques on renal arteries cause decrease flow to kidneys causing tissue damage and decrease function
damage to nephrons results in systemic fluid retension
excessive release of renin, results in vasoconstriction, water and salt retention, edema, increase blood volume and pressure
nocturia
failure
how is the CNS affected by hypertenion
transient ischemic attacks (mini strokes)
strokes
how are the arteries affected by hypertension
dissecting aneurysms
artherothrombotic obstruction
risk factors of hypertension
45 and above family history smokers - double risk diabetics races if darker skin men > women until menopause then equal pregnancy people with high stress levels high sodium high alcohol oral contraceptives obesity and/or physical activity
what is hypertension associated with
heart disease myocardial infaction angina pectoris left vent hypertrophy transient ischemic attacks and stroke diabetes metabolic disorders adrenal tumors
primary hypertension
idiopathic or essential
silent long term condition that is not associated with an underlying condition
about 90-95% of hypertension is essential
sign and symptoms of primary hypertension
- “silent killer” there are no symptoms. life expentancy decreases as blood pressure increases and specific organs at risk of damage
- if any: dizziness, headache, nausea, blurred vision, fatigue, lethargy, nose bleeds, mild edema, nocturia, exertional dyspnea
complications of primary hypertension
-chronic, slow progressive damage to vital organs
-aneurysm formation and rupture
-atherosclerosis
hyalinization (thickening) of capillary walls in an attempt to reinforce their strength leads to poor tissue health and slowed healing time
-death in 20-40 years: 60% due to chronic congestive heart failure; 30% due to cerebral haemorrhage; 10% due to kidney/liver/lung failure
secondary hypertension
occurs secondary to another condition, such as kidney disease, vascular disease or adrenal dysfunction (often a tumor) eclampsia & pre-eclampsia (pregnancy induced hypertension
signs and symptoms of secondary hypetension
nosebleeds severe headaches double vision considerable edema nausea/vomiting personality changes severe tinnitus convulsions emotional changes coma
complications of secondary hypertension
- death in a few days to a few years
- usually due to kidney failure, cerebral hemorrhage or acute congestive heart failure
- damage to blood vessels: thrombosis, aneurysm, embolism
- onion skinning: repeated scarring of vessel walls resulting in increased hypertension due to a decreased lumen and elasticity
- if hypertension is untreated it leads to pathological changes in BV
- atherosclerosis, stroke, heart attacks, peripheral heart disease
medications for hypertension
reccomended when BP is above 140/90 over 3-6 month period
- diuretics
- angiotensin-converting enzyme inhibitors
- beta-blockers
- calcium channel blockers
- vasodilator drugs
congestive heart failure
hearts inability to pump sufficient blood supply the bodys needs
what may CHF be secondary to
heart disease, chronic high BP, valvular disease, viral infection, alcoholism and other conditions that stress the heart
Hypotension:
A decrease in the systolic/diastolic BP below normal (95/60)
Orthostatic postural hypotension
An excessive fall in BP on assuming an upright position (a drop of 20mmHG in systolic or 10mmHG in diastolic pressure) This is not a disease but a manifestation of abnormal BP regulation due to variety of causes
Varicose Veins
Distended or dilated, abnormally large, elongated and bulging veins leading to venous insufficiency
Thrombophlebitis
Inflammation of a superficial or deep vein that leads to the formation of a thrombus (blood clot which is attached to the wall of a blood vessel)
Venous stasis
slow blood flow in the veins
Which 3 factors can affect systolic blood pressure?
- Stroke volume
- Speed of ejection
- Elasticity in the walls of the BV
Which 3 factors can affect diastolic blood pressure?
- Elasticity in the walls of the BV
- Competency of the aortic valve
- Resistance of the arterioles
What effect will stimulation of the vagus nerve have on heart rate?
parasympathetic stimulates the vagus nerve decreasing heart rate
Persistent hypertension increases the risk of which medical problems?
increases the risk of stroke, heart attack, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure.
how do dieuretics help lower BP
reduce sympathetic NS effects on vascular smooth muscle (decreases edema but may lead to heart arrhythmias)
how does Angiotensin-converting enzyme (ACE) inhibitors help lower BP
reduce vasoconstriction
how do beta blockers help reduce BP
inhibit the action of the sympathetic NS on vascular smooth muscle causing vasoconstriction
how do calcium channel blockers lower BP
reduce tone in venous and arterial smooth muscle and reduce cardiac output by inhibiting movement of calcium into cardiac and smooth muscle
how do vasodilator drugs lower BP
to decrease peripheral resistance through relaxation of the smooth muscle of the arterioles (but may produce tachycardia (rapid heartbeat) and contribute to salt and fluid retention)
Describe what happens in terms of blood volume with congestive heart failure:
Usually about 2/3rd’s of the blood volume in the heart is ejected with ventricular contraction this volume becomes progressively less (as low as 1/4 to 1/5) during heart failure, the remaining fluid causes dilation of the faulty ventricle and passive congestion of the organs proximal to it
What tissues will become congested with right ventricular heart failure?
Liver and limb congestion
What tissues will become congested with left ventricular heart failure?
lung congestion
class 1 CHF
no limitation is experienced in activates; there are no symptoms from ordinary activities
class 2 CHF
slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion
class 3 CHF
marked limitation of any activity; the patient is comfortable only at rest
class 4
any physical activity brings on discomfort and symptoms occur at rest
Why should full body MLD be avoided in a client with severe hypertension or CHF?
MLD with heart conditions because MT increases the flow of lymph towards the heart increasing congestion around the heart
What effect does petrissage have on arterial pressure?
causes initial increase followed by a decrease in pressure from peripheral vasodilation
what are the sx and sx of left ventricular CHF
- pulmonary congestion and edema
- dyspnea (laboured/difficult breathing) orthopenea (advanced dyspnea) and/or paroxysmal nocturnal dyspnea
- pulmonary edema
- hacking cough with frothy, bloody sputum
- tissue hypoxia
- decrease tolerance for exercise
- cerebral hypoxia
what are the sx and sx of right ventricular CHF
- edema distal to heart, including lower limbs (beginning with the ankles, sacral area and posterior thighs), liver, peritoneal cavity - chronic and pitted edema may develop
- impaired liver function
- enlarged spleen
- abdominal pain, intestinal problems, anorexia
- distension of jugular veins (upon standing)
- ***breathing less affected
Which types of techniques should be avoided in the treatment of someone with hypertension or CHF? Give examples.
- Prolonged painful techniques avoided because they increase the sympathetic nervous system firing therefore increase blood pressure
- Limit the number of painful techniques incorporated and the limit location
- Intersperse painful technique with soothing techniques
- Avoid vigorous stimulating techniques – cupping, hacking & pounding
- Avoid prolonged rotation of the neck during neck treatments as it could occlude BF
- Avoid simultaneous bilateral neck treatment (treat one side at a time)
- Avoid using repetitive long broad techniques (ex. Effleurage)
- Avoid repetitive full ROM, especially involving the limbs
- Avoid full body MLD
- Avoid full-body or extreme hydrotherapy applications
- Avoid Hydrotherapy applications to the chest, back and neck
Which types of techniques should be used in the treatment of someone with hypertension or CHF? Give examples.
- The goal is to decrease SNS firing
- Decrease pain and stress with soothing techniques
- Slow relaxed breathing
which positions should be avoided in someone with hypertension or CHF?
- avoid prolonged elevation of arms or legs above the heart (careful of pillow use)
- be careful of prone position because heart is lower than body part being treated and has to work harder
- avoid abdominal pillowing
which positions should be used in someone with HT or CHF
two or more pillows under the head and shoulders
which stages of uncontrolled hypertesion are completely CI’d for MT
very severe HT that is uncontrolled
if cx has controlled, very severe HT, what would be the position(s) to use for a back treatment
seated or side lying L side up
which essential oils may raise BP
hypertensive oils: rosemary, sage, thyme, camphor & hyssop
vasoconstriction oils: cypress, geranium & rosemary
how can you approach treatment of a limb when treating somebody with moderate HT or higher
begin on most distal part of the limb, using short segmental techniques and work proximally ending with the trunk treatment
list warnings of cardiac distress
increase HR rapid pulse labored breathing sweating or clamminess of skin extreme fascial flushing tissue bogginess and edema post massage
home care for cx with hypertension
- relaxation techniques (slow relaxed breathing, yoga, meditation)
- gentle modified exercising (mild to moderate levels of aerobic exercise walking, swimming), stretch and strengthen regime
- improve diet, address other risk actors as necessary
- essential oils - to facilitate decreased sympathetic NS firing
- marjoram, ylang ylang, lavender, lemon
define vasovagal syncope
sudden fainting due to hypotension induced by a nervous system response to abrupt emotional stress, pain or trauma
what is the function of valves in systemic veins
prevent back flow
what can result if systemic veins are incompetent
varicose veins
which vein is most affected with varicose
great saphenous
sx of varicose veins
- enlarged and bulging veins
- bluish veins appear lumpy
- can become tortuous
- more prominent when standing
- can be asymptomatic or cause dull achy px
- edema round ankles and lower legs
- itchiness on or around affected veins
- heavy, fatigued feeling in legs (making wlaking difficult); weakening of calf mm
- nocturnal leg cramps in calf mms
- sin over varicosities may appear shiny, bluish brown
special test for DVT
homans
What are your treatment goals for someone with varicose veins?
- Decrease and prevent fibrosis from edema and/or scar tissue adhesions through fascial and friction techniques surrounding but not on affected veins. These techniques must be modified or may be completely CI’d if client is using anticoagulants or if tissue is too fragile
- Increase ROM of affected joints, increase muscle strength, encourage drainage, and maintain joint health through active and passive movements, low-grade joint play and isometric or isotonic exercises for each affected joint o Passive and active movements of the joints in the lower limbs (hip, knee, ankle)
What is the recommended homecare for somebody with varicose veins?
- Encourage client to check with MD re: possible use of Support stockings or wraps
- Educate client on wearing looser clothing at the waist
- Avoiding prolonged periods of sitting or standing or crossing legs, avoid heavy lifting
- Sleep with feet elevated
- Care is taken not to scratch the skin over the varicosities as it may bleed and may cause an ulceration
- Maintain good foot care and frequently monitor limbs for signs of dermatitis, poor healing cuts and ulcers
- Standing in a cold foot bath, walking on the spot in cold water may assist swelling (dry thoroughly and wear warm socks)
- Light exercise such as walking to increase circulation
- Self-massage to the legs using cypress essential oil (avoid during pregnancy) to promote venous health
- AF ROM such as drawing the alphabet with ankles to increase circulation and mobility
- Elevate legs at least 3 times a day for about 10 minutes especially if they are on their feet for long periods of time
Which techniques are CI’s when client is taking anticoagulant drugs? Why
modify depth of pressure to prevent bruising
What does the alphabet have to do with homecare for a patient with varicose veins?
AF ROM such as drawing the alphabet with ankles to increase circulation and maintain ROM
