NUR 146 - Week 12 - PE and HTN Flashcards
Pulmonary Embolism:
What is it
Where does it usually originate?
Other causes
Obstruction of pulmonary artery or branches by a thrombus
- type of VTE (Venous thromboembolism)
Originates:
- Venous system
- Right side of heart
Other causes:
- Air, fat
- Amniotic fluid
Pulmonary Embolism:
V/Q mismatch
What does this result in?
Amount of air should be roughly even to amount of perfusion (Air coming in should match blood to alveoli)
- In regards to PE, not enough blood flow in relation to air coming in
What does this result in?
- V/Q results in pulmonary vasoconstriction –> pulmonary vascular resistance
- High PVR –> right sided heart failure
- Right ventricular failure –> decreased cardiac output, hypotension & cardiogenic shock
Pulmonary Embolism:
Clinical Manifestations
Symptoms dependent on size and location
Manifestations:
- Dyspnea
- Tachypnea
- Pleuritic chest pain (upon inspiration)
- Anxiety
- Fever
- Tachycardia
- Hemoptysis (coughing up blood)
- Syncope (passing out)
- Sudden death
Pulmonary Embolism:
Risk Factors
Virchow’s Triad:
Stasis, Trauma, hypercoagulability
- Immobilization
- Surgery
- Pregnancy
- Heart Failure
- A-Fib
- Varicose veins
- Hypercoagulable state
- Age >50
Pulmonary Embolism:
Prevention
Typical stuff
- Early ambulation
- Leg exercises
- anti-embolism stocking
- intermittent compression devices
- Don’t cross legs
Pulmonary Embolism:
Diagnostics
(Multi detector CT angiography) MDCTA - Gold standard
- Uses IV contrast; a lot of radiation
V/Q scan, if CTA unavailable
D- dimer
Stuff that WON’T work:
- CXR, EKG, Pulse ox, ABG; all will present fairly normal
What is the gold standard for diagnosing a PE?
Multi detector CT angiography (MDCTA)
PE:
Medical Management
Massive PE (Unstable): Hemodynamically unstable
- TPA (clot busters) administration
- Surgical embolectomy
- IVC filter for recurrent DVT –> PE
Stable PE: Normotensive and not hypoxic
- Immediate anti-coagulation is initiated
- PT will always require long term anti-coagulation
Rivaroxaban, apixaban:
What is it?
Indication
Advantages
Contraindications
Reversal Agent
Class: New Oral Direct Factor Xa Inhibitor
Indication:
- Treatment and prevention of DVT + PE
Advantages:
- Less food/drug interactions
- No need for lab monitoring
Contraindicated:
- Decreased renal function
Reversal agent:
- Andexanet alfa
What is the reversal agent for Rivaroxaban/apixaban
Andexanet alfa
PE:
Nursing Care
- Monitor patient’s response to thrombolytic therapy
- Oxygen therapy
- Monitor for signs of RHF or cardiogenic shock
- Patient education
Hypertension:
What is it
High blood pressure
- Leading risk factor for premature death or disability
HTN:
How is it defined?
Blood pressure is measured in
millimeters of mercury (mmHG)
Systolic BP: pressure in arteries
during ventricular systole
Diastolic BP: pressure in arteries
during ventricular diastole
HTN:
Diagnostics
Systolic blood pressure (SBP) ≥130mmHg
Diastolic blood pressure (DBP) ≥80mmHg
HTN:
What are the two types?
Primary hypertension:
- 95% of patients
- Unidentifiable cause
Secondary hypertension:
- 5% of patients
- Hypertension d/t another health condition
Common causes: chronic kidney disease, Cushing’s syndrome, hyperthyroidism, pheochromocytoma
HTN:
Classification of blood pressure in adults
Normal
Elevated
Stage I HTN
Stage II HTN
Normal bp:
Systolic <120mmHg and Diastolic <80 mmHg
Elevated blood pressure:
Systolic 120-129 mmHg and Diastolic <80
mmHg
Stage I Hypertension:
Systolic 130-139 mmHg or Diastolic 80-89
Stage II Hypertension: Systolic >140 mmHg or Diastolic >90
HTN:
Risk factors
Modifiable:
- Obesity
- Sedentary lifestyle
- Stress
- Excess sodium intake
- Excess alcohol intake
- Diabetes mellitus
- Smoking
- Hypercholesterolemia
Non modifiable:
- Age
- Gender
- Ethinicity
- Genetics
HTN:
Pathophysiology
Potential causes
Blood pressure = CO x PVR
- May be result of increased cardiac output, increased peripheral vascular resistance or both
Causes:
- Sympathetic activation
- Renal absorption of sodium + water
- RAAS activation
- Decreased vasodilation
- Insulin resistance
HTN:
Clinical manifestations
Usually asymptomatic; “silent killer”
Signs of target organ damage are late findings
- Retinal changes
- CAD
- MI
- PAD
- Renal dysfunction
- HF
- Stroke
HTN:
Abnormal BP readings
tl;dr = blood pressure at home is usually more accurate the BP readings in clinical
Masked HTN: Normal in facility, elevated at home
White coat HTN: Elevated in facility, normal at home
HTN:
History that may be indicative
HTN:
Goal
Medical Management
Goal: Prevent complications and death
Management:
- Maintain BP <130/80mmHG = lower morbidity & mortality
Lifestyle modifications: Weight loss, DASH diet, physical activity, decreased alcohol consumption, stop smoking
HTN:
Goal of Pharmacologic therapy
First line drugs
Goal: Treat hypertension without causing hypotension
First line drugs
- Thiazide diuretics
- Calcium channel blockers
- ACE inhibitors
- ARBs
Calcium channel blockers
Non-dihydropyridines vs. dihydropyridines
Non-dihydropyridines:
Diltiazem
- Slows conduction of cardiac impulse
Dihydropyridines:
Amlodipine
- Does not slow SA or AV node conduction
