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Nurs 2800 > Perfusion Chronic ex 2 > Flashcards

Perfusion Chronic ex 2 Flashcards

1
Q

Major risk factors for HTN

A

Sodium
Older age
African americans

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2
Q

what are they symptoms of HTN

A

none

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3
Q

symptoms related to target organ damage are seen late what are they

A

Retinal and other eye changes
renal hypertrophy
cardiac hypertrophy
Stroke
MI

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4
Q

Medical management for HTN

A

prevent complications and death by achieving and maintatingin bp

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5
Q

steps to improve HTN (management)

A

Lifestyle modifications
first line antihypertension (thiazide and ACE
Second line antihypertensives (beta blockers etc)

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6
Q

for older >65 adults what is their systolic goal

A

<130 systolic because of normal changes with aging

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7
Q

how do thiazide meds work

A

decreases volume - pee out fluid

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8
Q

what electrolyte are we worried about with thiazide

A

potassium

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9
Q

ace inhibitor

A

blocks A1 from converting to A2

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10
Q

aldosterone

A

makes your body retain fluid and sodium and lose potassium

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11
Q

adverse effect of ace inhibitor

A

cough
angioedema
hyperkalemia

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12
Q

ARB works by

A

Blocking aldoserone and a1
by blocking A2 receptors

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13
Q

Thiazide end in

A

thiazide

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14
Q

calcium channel blockers end with (and which ones dont)

A

-pine (HTN)
diltiazem (heart)
verapamil (heart)

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15
Q

Pregnant women first line medications because they cant have ACE or ARB medications

A

Calcium channel blockers (niphenidpine, lebatalol)

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16
Q

WHy cant pregnant women have ACE or ARB

A

angiotensin medications cause fetal defects

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17
Q

What to assess with HTN

A

BP, Symptoms for target organ damage (eye or retinal),
Risk factors (genes, smoking, health)
Lab tests: NOT DX and non specific (Urinalysis, blood chemistry, cholesterol, to find modifiable factors and is there damage)
Diagnostic procedures: again non specific, ECG, echocardiography

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18
Q

nursing hx and assessment for HTN

A

history and risk factors, assess potential symptoms of target organ damage, personal social and financial factors that will ifluence the condition or its treatment

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19
Q

Nursing Dx for HTN

A

deficient knowledge: regarding treatment and control of disease process

Nonadherence with therapeutic regimen: related to side effects of the therapy

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20
Q

collaborative problems and potential complications with HTN

A

target organs damage
MI
HF
LVH
TIA
CVA
Renal insufficiency and chronic kidney disease
retinal hemorrhage

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21
Q

planning and goals for HTN

A

understand disease process and treatment
they need to do self care
absence of complications
lower and controlling BP without adverse effects

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22
Q

interventions for HTN

A

education
reinforce and support lifestyle mods
taking medications as prescribed
Follow up that care

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23
Q

Diet for HTN

A

low sodium (<2400 mg or usuallly seen as <2G)

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24
Q

Lifestyle changes for HTN

A

exercise (30 minutes every day)
alcohol in moderation (women 1, men 2)
quit smoking
lose weight

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25
Q

Evaluation and outcome

A

good BP <130
understand the disease
adhere to the treatment plan
stable labs (BUN and serum creatinine)
no complications (no organ damage)

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26
Q

Gerontologic considerations in HTN

A
  1. meds can be hard to remember to take (Set alarm)
  2. expense
  3. monotherapy to simplify taking meds
    understanding the regimen and physically can open and read the med containers
  4. include family and care givers
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27
Q

Initial medication with uncomplicated HTN and no specific indications for another medication?

A

Go to medication -> Thiazide diuretic, and apparently ACE

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28
Q

Initial medication with uncomplicated HTN and patient is African American?

A

Calcium channel blockers

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29
Q

education plan for new HTN pain

A

30 minutse of regular aerobic physical activity
reduce alcohol
reduce sodium to 2400 mg
BMI 18-25 (don’t get Michelle started on this)

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30
Q

atherosclerosis symptoms

A

narrowed vessels in specific areas (heart = chest pain) cause the pain and issues

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31
Q

Complications of atherosclerosis

A

MI, HF, sudden cardiac death

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32
Q

risk factors

A

older adults but can happen in late teens
male until women hit menopause
cigarette smoking
metabolic syndrome
obesity
diabetes and HTN
* inflammatory markers homocysteine enzyme
Cholesterol pannel

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33
Q

prevent artherosclerossis monitor

A

Cholesterol and lipid panels at the age of 20

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34
Q

LDL levels need to be less than

A

100

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35
Q

total cholesterol less than

A

200 mg/dl

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36
Q

HDL greater than

A

40 mg/dl for men and 50 for women

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37
Q

statins major complications

A

rabdo, myopathy, liver failure

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38
Q

Medication used for reducing cholesterol

A

Statins

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39
Q

Stable angina is

A

chest pain is brought on by increased oxygen demand that the body cannot achieve; pain relieved by rest

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40
Q

Unstable is

A

chest pain is brought on by increased oxygen demand that the body cannot achieve; pain NOT relieved by rest

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41
Q

Variant (prinzmetal) is

A

spasms cause pain

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42
Q

Silent angina

A

no signs or symptoms of heart ischemia

43
Q

Who share symptoms

A

Angina and CAD

44
Q

DX findings for angina

A

ECG
LABS: CK, CKMB, troponin
Stress test
cardiac cath
coronary angiography

45
Q

medical management of angina

A

decrease O2 demand and provide O2
O2
drugs
risk factors
cath
then cardiac rehab

46
Q

medical management of angina

A

nitrates #1, vedy vedy fast
BETA- blockers (LOL)
CCBS (amlodipine and dilt
Antiplatelet drugs
anticoagulants

47
Q

Nitrates are

A

vasodilators

48
Q

Beta blockers

A

reduce myocardial oxygen consumption
Inotropic and cronotropic

49
Q

Beta blocker used for someone with COPD

A

Selective - otherwise really back for lungs

50
Q

Calcium channel blockers (-PINE)

A

decrease chronotropic and inotropic phenoms, causes dilation

51
Q

antiplatelet drugs for Angina

A

ASA and Clopidogrel (plavix)

52
Q

Aspirin MOA

A

decrease ATP and current platelet formation

53
Q

anticoagulant (heparin)

A

given to prevent subsequent thrombus

54
Q

phases of cardiac rehabilitation

A

1 dx educate
2 after dischage exersise training
3 maintain exercise on own and longterm care

55
Q

assessment and dx angina

A

pain assessment (SEE CHART 27-4)

56
Q

Nursing dx for angina

A

risk for decreased cardiac tissue prefussion
knowledge deficit
anxiety

57
Q

acute coronary syndrome aka

A

MI

58
Q

Problems with angina

A

dysthythmias, CA, HF, MI, cardiogenic shock

59
Q

What are nurses primary care plan for angina

A

decrease O2 demand and increase O2
Give o2
get rest

60
Q

call light is on and the pt complains of chest pain

A
  • stop what they’re doing and rest (sit lay down)
  • Assess angina
  • VS, page someone for 12 lead ecg, get orders for nitro, and supplemental O2
  • Reduce anxiety (imagery, music)
61
Q

why do we give nitro 3x for chest pain

A

if not relieved by the 2nd or 3rd dose most likely not stable angina and if unstable angina might be MI

62
Q

MONA acronym

A

Morphine, O2, Nitro, Aspirin

63
Q

Reperfusion procedures for angina

A

percutaneous coronary intervention (PCI)
Coronary artery bypas graft

64
Q

PCI is and what is it used for

A

percutaneous coronary intervention is used to open occluded coronary artery to promote reperfusion

65
Q

CABG

A

coronary artery bypass graft
move the arteries around in heart to reperfuse

66
Q

what causes altered vascular perfusion in arteries and veins

A

pump failure
alterations in blood and lymphatic vessels
circulatory insufficiency of extremities

67
Q

What is worse (Acute or gradual) occlusion

A

sudden - no alternative pathways

68
Q

changes occur distal to the level of obstructions so what are the priority manifestations of PAD

A
  • intermittent claudication (pain with walking)
  • paresthesia (nerve endings don’t get o2 so they start to tingle)
  • Shiny tight hairless skin with thickening toenails
  • pulses decreased/ absent
  • dependent rubor
69
Q

what is elevation pallor

A

raise legs and further reduces perfusion in PAD

70
Q

Rest pain

A

not even out of pain at rest and not perfusing

71
Q

cilostazol

A

treats intermittent claudication

72
Q

Drugs for PAD

A

treats intermittent claudication
antiplatelet drugs (asa and clopidogrel)
statin: decrease cholesterol and also help with

73
Q

endovascular (radiologic) management

A

establish adequate inflow to the distal vessel by balloon angioplasty, stent, drug-eluting

74
Q

Surgical management for PAD

A

reserved for severe and disabling claudication they do a balloon angioplasty and stent angioplasty OR they choose amputation

75
Q

enastamosis

A

cut and redirect the vessel to another healthy one and sew it to that

76
Q

Nursing asesssment for Arterial ulcers

A

Location: toes, feet, skin
Appearance: Deep, pale
Skin: normal atrophic, pallor when elevated; dependent rubor, thick, toenails, shiny and hairless skin
Skin temp: cool
No edema or very mild
severe pain all the time
gangrene may occur
pulses decreased or absent, possible bruit

77
Q

Shape of arterial ulcers

A

Nice and round

78
Q

Art ulcers are

A

pulselessness, pain, pallor, poikilothermic,

79
Q

whar are the planning goals once PAD has been established?

A

increase blood flow
vasodilate with medications
don’t compress the goddamn legs
adherence to self care plain

80
Q

How to promote health with ART ulcers

A

warm not too hot not too cold
heart healthy diet (low sodium, low fat, low cholesterol)
exercise up until the intermittent claudication and then fucking stop
medically managed exercises (ask a doctor)

81
Q

promote arterial dilation as a nurse

A
  • Dangle their feet
  • warm everything (not hot not cold)
  • no heat on lower extremities (no hot bath due to decreased sensation)
  • avoid trauma to lower extremities (wear shoes)
  • lotion not between the toes
  • diet
82
Q

implimentation for arterial insufficiency

A

reduce further disease
quit smoking
weight loss
BP<140/90 diabetics <130/80
Glycosylated hemoglobin <7.0 for diabetic
meticulous foot inspection and care
avoid heating blankets (KEEP THEM WARM NOT HOT)

83
Q

Do people with peripheral venous disease experience pain?

A

not really, maybe achy, but not a perfusion issue so no pain

84
Q

Virchows triad

A

venous stasis, hypercoagulability, endothelial injury

85
Q

Risks for venous disease

A

varicose veings, cardiovascular disease

86
Q

manifestations of PVD

A

Edema, Brown pigmentation of skin, aching of lower extremities, statis dermatitis, venous ulcrs

87
Q

statsis dermatitis

A

a common type of eczema that develops in people who have poor blood flow.

88
Q

Telltale sign of peripheral veous disease

A

Brown pigmentation of skin

89
Q

area where PVD forms

A

Gator area (ankle biter area)

90
Q

How to manage peripheral venous disease for chronic

A

reduce venous stasis and prevent ulcerations
elevate feet, no prolonged sitting standing or walking

91
Q

surgical management of PVD

A
  • IVC filters (giant net for dvt)
  • vein stripping ligation (varicose veins)
  • sclerotherapy (inject a chemical to vein directly to collapse vein)
92
Q

venous stasis ulcer assessment

A

Location: gator (medical/anterior ankle
Ulcer appearance Superficial/ pink
Skin brown discoloration, dermatitis, cyanosis
Skin temp: normal
Edema: may be significant
Pain: usually mild; aching and dull
Gangrene DOES NOT OCCUR
pulses are normal

93
Q

venous ulcers are more common than Arterial ulcers T/F

A

True

94
Q

promote venous return and treat pain for PVD as a nurse

A

Graduated compression
elevate extremity
exercise (AROM/PROM
massage
pain meds
anticoagulant/ thrombolytic therapy
exudate management - wound vac

95
Q

Evaluation of PVD?

A

did they do their things

96
Q

intermittent claudication is gold star remember this Victoria for what disease

A

peripheral artery disease

97
Q

what is initial assessment for PAD

A

Skin integrity
leg color - up pale, down red
toe nails - yuk
ulcers?

98
Q

medications for PAD

A

Aspirin, simvastatin, Ramipril (ACE inhibitor), pentoxifylline (intermittent claudication)

99
Q

teaching people about asprin

A

take with food no babies

100
Q

Teaching people about simvastatin

A

jaundice, GI effects NV and take with food

101
Q

teaching people about Ramipril

A

angioedema and cough. take your BP and when to hold medication

102
Q

Goal of medical management for HTN

A

To prevent complication and death by maintaining BP

103
Q

What does the medication for HTN do

A

Decreases vascular resistance
Blood volume
Decrease strength heart contraction
Decrease rate of heart

Nurs 2800 (16 decks)

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