Perfusion Chronic ex 2 Flashcards
Major risk factors for HTN
Sodium
Older age
African americans
what are they symptoms of HTN
none
symptoms related to target organ damage are seen late what are they
Retinal and other eye changes
renal hypertrophy
cardiac hypertrophy
Stroke
MI
Medical management for HTN
prevent complications and death by achieving and maintatingin bp
steps to improve HTN (management)
Lifestyle modifications
first line antihypertension (thiazide and ACE
Second line antihypertensives (beta blockers etc)
for older >65 adults what is their systolic goal
<130 systolic because of normal changes with aging
how do thiazide meds work
decreases volume - pee out fluid
what electrolyte are we worried about with thiazide
potassium
ace inhibitor
blocks A1 from converting to A2
aldosterone
makes your body retain fluid and sodium and lose potassium
adverse effect of ace inhibitor
cough
angioedema
hyperkalemia
ARB works by
Blocking aldoserone and a1
by blocking A2 receptors
Thiazide end in
thiazide
calcium channel blockers end with (and which ones dont)
-pine (HTN)
diltiazem (heart)
verapamil (heart)
Pregnant women first line medications because they cant have ACE or ARB medications
Calcium channel blockers (niphenidpine, lebatalol)
WHy cant pregnant women have ACE or ARB
angiotensin medications cause fetal defects
What to assess with HTN
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
nursing hx and assessment for HTN
history and risk factors, assess potential symptoms of target organ damage, personal social and financial factors that will ifluence the condition or its treatment
Nursing Dx for HTN
deficient knowledge: regarding treatment and control of disease process
Nonadherence with therapeutic regimen: related to side effects of the therapy
collaborative problems and potential complications with HTN
target organs damage
MI
HF
LVH
TIA
CVA
Renal insufficiency and chronic kidney disease
retinal hemorrhage
planning and goals for HTN
understand disease process and treatment
they need to do self care
absence of complications
lower and controlling BP without adverse effects
interventions for HTN
education
reinforce and support lifestyle mods
taking medications as prescribed
Follow up that care
Diet for HTN
low sodium (<2400 mg or usuallly seen as <2G)
Lifestyle changes for HTN
exercise (30 minutes every day)
alcohol in moderation (women 1, men 2)
quit smoking
lose weight
Evaluation and outcome
good BP <130
understand the disease
adhere to the treatment plan
stable labs (BUN and serum creatinine)
no complications (no organ damage)
Gerontologic considerations in HTN
- meds can be hard to remember to take (Set alarm)
- expense
- monotherapy to simplify taking meds
understanding the regimen and physically can open and read the med containers - include family and care givers
Initial medication with uncomplicated HTN and no specific indications for another medication?
Go to medication -> Thiazide diuretic, and apparently ACE
Initial medication with uncomplicated HTN and patient is African American?
Calcium channel blockers
education plan for new HTN pain
30 minutse of regular aerobic physical activity
reduce alcohol
reduce sodium to 2400 mg
BMI 18-25 (don’t get Michelle started on this)
atherosclerosis symptoms
narrowed vessels in specific areas (heart = chest pain) cause the pain and issues
Complications of atherosclerosis
MI, HF, sudden cardiac death
risk factors
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
prevent artherosclerossis monitor
Cholesterol and lipid panels at the age of 20
LDL levels need to be less than
100
total cholesterol less than
200 mg/dl
HDL greater than
40 mg/dl for men and 50 for women
statins major complications
rabdo, myopathy, liver failure
Medication used for reducing cholesterol
Statins
Stable angina is
chest pain is brought on by increased oxygen demand that the body cannot achieve; pain relieved by rest
Unstable is
chest pain is brought on by increased oxygen demand that the body cannot achieve; pain NOT relieved by rest
Variant (prinzmetal) is
spasms cause pain
Silent angina
no signs or symptoms of heart ischemia
Who share symptoms
Angina and CAD
DX findings for angina
ECG
LABS: CK, CKMB, troponin
Stress test
cardiac cath
coronary angiography
medical management of angina
decrease O2 demand and provide O2
O2
drugs
risk factors
cath
then cardiac rehab
medical management of angina
nitrates #1, vedy vedy fast
BETA- blockers (LOL)
CCBS (amlodipine and dilt
Antiplatelet drugs
anticoagulants
Nitrates are
vasodilators
Beta blockers
reduce myocardial oxygen consumption
Inotropic and cronotropic
Beta blocker used for someone with COPD
Selective - otherwise really back for lungs
Calcium channel blockers (-PINE)
decrease chronotropic and inotropic phenoms, causes dilation
antiplatelet drugs for Angina
ASA and Clopidogrel (plavix)
Aspirin MOA
decrease ATP and current platelet formation
anticoagulant (heparin)
given to prevent subsequent thrombus
phases of cardiac rehabilitation
1 dx educate
2 after dischage exersise training
3 maintain exercise on own and longterm care
assessment and dx angina
pain assessment (SEE CHART 27-4)
Nursing dx for angina
risk for decreased cardiac tissue prefussion
knowledge deficit
anxiety
acute coronary syndrome aka
MI
Problems with angina
dysthythmias, CA, HF, MI, cardiogenic shock
What are nurses primary care plan for angina
decrease O2 demand and increase O2
Give o2
get rest
call light is on and the pt complains of chest pain
- 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)
why do we give nitro 3x for chest pain
if not relieved by the 2nd or 3rd dose most likely not stable angina and if unstable angina might be MI
MONA acronym
Morphine, O2, Nitro, Aspirin
Reperfusion procedures for angina
percutaneous coronary intervention (PCI)
Coronary artery bypas graft
PCI is and what is it used for
percutaneous coronary intervention is used to open occluded coronary artery to promote reperfusion
CABG
coronary artery bypass graft
move the arteries around in heart to reperfuse
what causes altered vascular perfusion in arteries and veins
pump failure
alterations in blood and lymphatic vessels
circulatory insufficiency of extremities
What is worse (Acute or gradual) occlusion
sudden - no alternative pathways
changes occur distal to the level of obstructions so what are the priority manifestations of PAD
- 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
what is elevation pallor
raise legs and further reduces perfusion in PAD
Rest pain
not even out of pain at rest and not perfusing
cilostazol
treats intermittent claudication
Drugs for PAD
treats intermittent claudication
antiplatelet drugs (asa and clopidogrel)
statin: decrease cholesterol and also help with
endovascular (radiologic) management
establish adequate inflow to the distal vessel by balloon angioplasty, stent, drug-eluting
Surgical management for PAD
reserved for severe and disabling claudication they do a balloon angioplasty and stent angioplasty OR they choose amputation
enastamosis
cut and redirect the vessel to another healthy one and sew it to that
Nursing asesssment for Arterial ulcers
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
Shape of arterial ulcers
Nice and round
Art ulcers are
pulselessness, pain, pallor, poikilothermic,
whar are the planning goals once PAD has been established?
increase blood flow
vasodilate with medications
don’t compress the goddamn legs
adherence to self care plain
How to promote health with ART ulcers
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)
promote arterial dilation as a nurse
- 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
implimentation for arterial insufficiency
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)
Do people with peripheral venous disease experience pain?
not really, maybe achy, but not a perfusion issue so no pain
Virchows triad
venous stasis, hypercoagulability, endothelial injury
Risks for venous disease
varicose veings, cardiovascular disease
manifestations of PVD
Edema, Brown pigmentation of skin, aching of lower extremities, statis dermatitis, venous ulcrs
statsis dermatitis
a common type of eczema that develops in people who have poor blood flow.
Telltale sign of peripheral veous disease
Brown pigmentation of skin
area where PVD forms
Gator area (ankle biter area)
How to manage peripheral venous disease for chronic
reduce venous stasis and prevent ulcerations
elevate feet, no prolonged sitting standing or walking
surgical management of PVD
- IVC filters (giant net for dvt)
- vein stripping ligation (varicose veins)
- sclerotherapy (inject a chemical to vein directly to collapse vein)
venous stasis ulcer assessment
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
venous ulcers are more common than Arterial ulcers T/F
True
promote venous return and treat pain for PVD as a nurse
Graduated compression
elevate extremity
exercise (AROM/PROM
massage
pain meds
anticoagulant/ thrombolytic therapy
exudate management - wound vac
Evaluation of PVD?
did they do their things
intermittent claudication is gold star remember this Victoria for what disease
peripheral artery disease
what is initial assessment for PAD
Skin integrity
leg color - up pale, down red
toe nails - yuk
ulcers?
medications for PAD
Aspirin, simvastatin, Ramipril (ACE inhibitor), pentoxifylline (intermittent claudication)
teaching people about asprin
take with food no babies
Teaching people about simvastatin
jaundice, GI effects NV and take with food
teaching people about Ramipril
angioedema and cough. take your BP and when to hold medication
Goal of medical management for HTN
To prevent complication and death by maintaining BP
What does the medication for HTN do
Decreases vascular resistance
Blood volume
Decrease strength heart contraction
Decrease rate of heart
