Test 2 Vascular Problems Flashcards
High Blood Pressure is most common in this group…
Is this trend going down year-by-year
Black females 42.9 %
Black Male 40.3%
The trend is increasing in High Blood Pressure
Blood Pressure Categories
Normal
Elevated
HTN Stage 1
HTN Stage 2
Hypertensive Crisis
Normal <120/ <80
Elevated 120- 129 / <80
HTN Stage1 130 - 139 / 80 - 89
HTN Stage 2 >140 / OR > 90
Hypertensive Crisis >180 and /or >120
Define Blood Pressure
120- 129 / <80
Elevated
Define BP
130 - 139 / 80 - 89
HTN Stage 1
Define blood pressure
> 140 / OR > 90
HTN Stage 2
Define blood pressure
> 180 and /or >120
Hypertensive Crisis
Define “Resistant” HTN
Elevated despite treatment with 3 or more antihypertensive meds
HTN Urgency Define reading…
HTN Emergency Define reading…
> 180 & or >120
> 180 + Target organ damage & or >120 + Target organ damage
BP control systems
Define how they work
Arterial baroreceptors…..
Renal blood flow….
RAAS…..
Vascular Auto-Regulation….
Arterial baroreceptors (Sense Pressure)
Renal blood flow (Retention or Diuresis)
RAAS (Na & H²O Retention)
Vascular Auto-Regulation (Auto-Regulation)
Cause of Essential HTN…
Cause of Secondary HTN…
Essential: No known cause
Secondary:
Diseases (Kidney/adrenal, Aortic Narrow, Brain, Obstructive Sleep Apnea)
Meds: Estrogen, Steroids, Sympathetic
Food (High Cholesterol)
Chlorothiazide
Chlorothalidone
Hydrochlorothiazide
Metolazone
Tyoe of med…
Action….
Avoid with these health issues…
Teaching….
Thiazide diuretics
Prevents Na & H2O Reabsorption in distal tubules. Increase K excretion
Avoid with: Gout, hyponatremia, bipolar disorder
Teaching: Replace K & Can increase BS if diabetic
Furosemide
Bumetanide
Torsemide
Ethacrynic Acid
Examples of which med…
Loop Diuretic
Amiloride
Eplerenone
Spironolactone
Triamterene
Type of medication….
K sparing Diuretucs
Amlodipine
Felodipine
Nicardipine
What is special about these CCBs
Dihydropyridines (DHPs):
Used to control HTN
Name 3 CCB that are used to control HTN
Dihydropyridines
Amlodipine
Felodipine
Nicardipine
Verify K levels before giving which meds. SATA
Hydrochlorothiazide
Furosemide
Spironolactone
Lisinopril
All the above
(Prevent Hypokalemia)
Hydrochlorothiazide
Furosemide
(Prevent Hyperkalemia)
Spironolactone
Lisinopril
ACE Inhibitors Prevent conversion of angiotensin I to angiotensin II in the lungs. This can cause..
Unrelating cough
Alpha blockers
Prazosin
Doxazosin
Terazosin
(3) affects beside lower BP
Give (3)
Lower LDL
Increase sensitivity to insulin
Prevents vasoconstriction
Central Alpha Blockers (Lower BP)
Methyldopa
Clonidine
SE….
Somnolence & Dry mouth
Central alpha blockers (Lower BP)
SE: Somnolence & Dry mouth
Give 2 examples….
Methyldopa
Clonidine
Hydralazine
Minoxidil
Nitroprusside
Type of medications….
Action…..
Direct Vasodilators
Action: Vasodilates arterial smooth muscle
Hydralazine
Minoxidil
Nitroprusside
Direct Vasodilators
Hydralazine
Minoxidil
Nitroprusside
*Start Low & slow increase dose
SE: (4)
Use:
SE
Reflex Tachycardia
Orthostatic hypotension
Headache
Facial Flushing
Use: Lower BP
Direct Renin Inhibitor
Aliskiren
Action….
Inhibits Renin to lower BP
Aliskiren
Action: Inhibits Renin in blood stream to lower BP
Class….
Direct Renin Inhibitor
Peripheral Arterial Disease
Arterial & Venus
Patho:
Systemic Atherosclerosis
Total / Partial Arterial obstruction
Death of tissue below obstruction
Risk factors (6)
HTN
Cholesterol
DM
SMOKING
Obesity
Genetics
Age
Intermittent claudication….
Define
Leg pain with activity that improves with rest.
Intermittent Claudication: Pain occurs predictably with activity and subsides with rest.
Critical Limb Ischemia (Rest Pain):
Pain at rest, indicating severe blood flow restriction.
Both happen with which disease….
Peripheral Arterial Disease
To reduce pain from intermittent Claudication elevate legs above heart level.
T or F
F
Dangle legs (Allows blood from Artery to perfuse to lower extremities)
Elevation of legs is used for Venus return
Pallor: Pale or whitish skin, especially when the leg is (dependent/ elevated)
Rubor: A reddish-purple discoloration of the foot or leg when it is in a (dependent / elevated) position.
Pallor = Elevated.
Dependent Rubor
Shiny, Thin Skin: Atrophy of the skin due to chronic ischemia.
Cool to Touch:
Dryness and Scaling: Lack of moisture due to decreased circulation.
This problem…
PAD
Often located on the toes, heels, or pressure points.
Edges are punched out and well-defined.
Wound bed is typically pale or necrotic with minimal drainage.
Gangrene: May lead to tissue death, causing black, necrotic areas on the toes or feet
Problem
PAD
To test for PAD assess
Segmental blood pressure measurement (ABI)
BP in thigh, calf, ankle should be (Higher/ Lower) than brachial…
Higher
Ankle / Brachial = PAD if number is <0.9
Testing for PAD
Blood flow to the extremities should decrease immediately after exercise
T or F
F
Should increas
Plethysmography…
Measures amount of blood or air in a part of the body.
Used to determine PAD
Pentoxifylline
Action….
Use…
Action: reducing blood viscosity and improving microcirculation
Use: improves blood flow
Peripheral perfusion drugs
Aspirin
Clopidogrel
Cilostazol
Pentoxifylline
Class: Vasodilator Phosphodiesterase-3 inhibitor.
Use: Improves walking distance in PAD by increasing blood flow and reducing claudication.
Class: P2Y12 receptor inhibitor (antiplatelet).
Use: Reduces clot formation in conditions like PAD, stroke, and after stent placement.
Class: Hemorheologic agent.
Use: Treats intermittent claudication by reducing blood viscosity and improving red blood cell flexibility.
Class: Antiplatelet agent.
Use: Prevents blood clots by inhibiting platelet aggregation; used in cardiovascular disease and PAD.
Describe…
(ASPIRIN)
Class: Antiplatelet agent.
Use: Prevents blood clots by inhibiting platelet aggregation; used in cardiovascular disease and PAD.
(CLOPIDOGREL)
Class: P2Y12 receptor inhibitor (antiplatelet).
Use: Reduces clot formation in conditions like PAD, stroke, and after stent placement.
(Cilostazol)
Class: Vasodilators Phosphodiesterase-3 inhibitor.
Use: Improves walking distance in PAD by increasing blood flow and reducing claudication.
(PENTOXIFYLLINE)
Class: Hemorheologic agent.
Use: Treats intermittent claudication by reducing blood viscosity and improving red blood cell flexibility.
An axillofemoral graft is used to bypass blocked or narrowed arteries, typically in cases of ____(2)____ when direct surgical access to the affected area is difficult or unsafe
aortic aneurysms
Severe peripheral arterial disease (PAD)
Femoral popliteal bypass is used for these disease…
peripheral arterial disease (PAD) or severe leg ischemia.
Acute Arterial Occlusion
Manifestación: 6 Ps of ischemia
Pain
Pulseless
Paralysis
Pallor
Paresthesia
Poikilothermia
(body temperature that fluctuates with the surrounding environment)
Acute Arterial Occlusion
Pain
Pulseless
Paralysis
Pallor
Paresthesia
Poikilothermia
(body temperature that fluctuates with the surrounding environment)
Treatment….
Heparin
Thrombolytics
Embolectomy
Tissue pressure restricts blood flow and causes ischemia & tissue death
Manifestions;
Severe pain
Edema
Muscle tenderness
Poor cap refill
Name problem and treatments
Compartment Syndrome
Elevate limb above heart
Fasciotomy
Bypass graft quality surveillance (2)
ABI & Duplex Doppler
Patient had right femoral popliteal bypass graft 4 hrs ago. Which assessment Findings should a nurse communicate immediately to HCP
Right foot warm, red and edematous
Left foot has a weak pulse
Patient complains for right leg pain.
Foot is pale & has poor cap refill
Foot is pale & has poor cap refill
Permanent localized dilation of an artery
Aneurysms
Causes of Aneurysms (Permanent localized dilation of an artery)
(4)
Atherosclerosis
Syphilis
Marfan syndrome
HTN
Class most at risk for Aneurysms
Men >65
History of smoking >100 ciggys
Abdominal
Pulsatile mass over upper mid-abdomen
Bruit over mass
Pain in abdomen
Thoracic
Mass above sternal notch
SOB, hoarseness, difficulty swallowing
Back pain
Aneurysms Manifestions
Endovascular Aneurysm Repair (EVAR), Abdominal Aortic Aneurysm (AAA) Resection,
Thoracic Aortic Repair
Surgical management of aneurysms
Problem: Ineffective tissue Perfusion
Aortic dissection
Sudden tear in ____ lining
Intimal
Raynauds disease (Primary) & Phenomenon (Secondary to other disease- More serious- leads to ulcers/gangrene)
Describe….
Manifestions….
Vasospasm of arteries & arterioles. Made worse by Cold Temperatures, Stress, Smoking
Red, White, and Blue skin
Cold, pain, number, edema
Which is wrong during the 1st 24 hrs post abdominal aneurysms repair with a graft and a NG tube.
Elevated be >45 to prevent aspiration
Notify resident if urine output is <50ml/hr
Maintain BP 110 - 150 SYSTOLIC
Cough & Deep breath every 1 - 2 hrs, splint incision
- Is wrong
elevated at 30 to 45 degrees (semi-Fowler’s position) unless contraindicated.
Causes of Secondary HTN
Diseases (4)
Meds: (3)
Other (1)
Diseases (Kidney/adrenal, Aortic Narrow, Brain, Obstructive Sleep Apnea)
Meds: Estrogen, Steroids, Sympathetic
Food (High Cholesterol)
Diuretics
CCB
ACE & ARB
Alpha blockers
Central Alpha Blockers
Beta Blockers
Adrenergic Blockers
Direct Vasodilators
Direct Renin Inhibitor
For which problem…
HTN
Medications for HTN (8)
Diuretics
CCB
ACE & ARB
Alpha blockers
Central Alpha Blockers
Beta Blockers
Adrenergic Blockers
Direct Vasodilators
Direct Renin Inhibitor
Amlodipine
Felodipine
Nicardipine
CCB used for treatment of HTN
What is the primary use of CCB….
Non-ventricular tachycardia or
Angina treatment
Which is Beta-Blockers/ CCB
Vasodilation, decreased cardiac contractility, and reduced heart rate
Result: Decreased heart rate, reduced cardiac output, and lower renin release from the kidneys.
CCB
Vasodilation, decreased cardiac contractility, and reduced heart rate (in non-dihydropyridine CCBs).
Beta Blockers (BBs):
Block beta-adrenergic receptors (primarily β1 in the heart and β2 in the lungs and vasculature).
Result: Decreased heart rate, reduced cardiac output, and lower renin release from the kidneys.
ACE Inhibitors cause (Arterial or Venous) Vasodilation; Decreasing SVR.
Both
Arterial & Venous Vasodilation to Decrease SVR
Prevent reuptake of norepinephrine in vascular smooth muscle to prevent vasoconstriction.
Class…
Examples…
Alpha Blockers
Prazosin
Doxazosin
Terazosin
Alpha Blockers reduce HTN by
Preventing reuptake of norepinephrine in vascular smooth muscles to prevent vasoconstriction.
Name Suffix of Alpha Blockers…
Give examples…
Major SE…
ZOSIN
Prazosin
Doxazosin
Terazosin
SE: First Dose Hypotension
Blocks sympathetic activity in the brainstem to reduce outflow to the heart and blood vessels.
Class…
Examples…
Central Alpha Blockers
Methyldopa
Clonidine
Give example of the Only Direct Renin Inhibitor discussed…
Aliskiren
Peripheral perfusion drugs
Aspirin
Clopidogrel
Cilostazol…..
Pentoxifylline….
Describe….
Cilostazol: Vasodilator
Pentoxifylline: Increases RBC flexibility
Legs swollen, tight, pale and shiny. Swollen muscle compresses blood vessels and nerves in the extremity.
Name condition…
Compartment syndrome
Where will a thoracic aneurysm be located…
Above sternal knotch
Describe EVAR…
What is it used for….
Endovascular Aneurysm repair
A fabric coated stent is placed in the area of the artery with the Aneurysm. Blood flows through stent instead of into the surrounding Aneurysm.
Abdominal Aortic Aneurysm (AAA) resection refers to an open surgical procedure to repair an aneurysm in the abdominal aorta by removing the diseased segment and replacing it with a synthetic graft.
This method is often used when the aneurysm is unsuitable for a minimally invasive procedure like _____ or in emergency situations such as a ruptured aneurysm.
EVAR
Endovascular Aneurysm Repair
Describe Virchows Triad…
Endothelial injury
Venous Statis
Hypercoagability
Risk Factors
Surgery (Hip,Knee, Prostate)
Immobility
Phebilitis
Cancer
UC
HF
Oral contraceptives
Venous Thromboembolism
For venous thromboembolism
Leg in this posistion…
Elevated to return blood to heart
Diagnosis for venous thromboembolism
D-dimer
Venous US
Give this med for home therapy for stable DVT / PE
Enoxaparin / Lovenox
Dalteparin / Fragmin
Ardeparin / Normoflo
Low Molecular Weight Heparin
Enoxaparin / Lovenox
Dalteparin / Fragmin
Ardeparin / Normoflo
Class of med…
Use…
Low molecular weight heparin
Home therapy for DVT & PE
How long for Warfarin to reach therapeutic level…
3 or 4 days
Quickly Disolve thrombi and prevent venous insufficiency
Class…
Contradictions…
Thrombolytics
Contradictions
Post-op
Preggers
Trauma / Bleeding
Stroke
Causes of Venous Insufficiency (4)
Standing
Sitting in 1 posistion prolonged
Preggers
Obesity
(Throbosis or damaged valves cause blood back up)
RBC and waste products accumulation in tissues causing swelling, cellulitis, ulcers…
Venous insufficiency
Inflammation of the superficial vein caused by an irritant…
Phlebitis
Phlebitis
Superficial vein inflammation caused by an irritant.
Treatment…
Remove IV
Warm compress
CVI (Chronic Venous Insufficiency)
Veins in the legs fail to return blood to the heart effectively. This is often due to…
Damaged or weakened vein valves, which allow blood to pool and cause increased pressure.
PAD or Venous Insufficiency
Appearance: Cool, pale skin, reduced hair growth on legs, thickened toenails, and ulcers on the toes or feet that are often painful.
Swelling in the lower legs and ankles, darkened or discolored skin (stasis dermatitis), and the development of ulcers around the ankle area.
PAD
Appearance: Cool, pale skin, reduced hair growth on legs, thickened toenails, and ulcers on the toes or feet that are often painful.
Venous Insufficiency
Swelling in the lower legs and ankles, darkened or discolored skin (stasis dermatitis), and the development of ulcers around the ankle area.
Risk Factors:
Smoking, diabetes, high blood pressure, high cholesterol, older age, family history of vascular disease, and sedentary lifestyle.
Obesity, pregnancy, prolonged standing, age, family history, prior blood clots (deep vein thrombosis), and leg injury.
PAD:
Smoking, diabetes, high blood pressure, high cholesterol, older age, family history of vascular disease, and sedentary lifestyle.
Venous Return Issues (CVI):
Obesity, pregnancy, prolonged standing, age, family history, prior blood clots (deep vein thrombosis), and leg injury.
Diagnosis
PAD or Venous return
Ankle-Brachial Index (ABI): A test that compares blood pressure in the ankle and arm to assess blood flow to the legs.
Doppler Ultrasound: Measures blood flow velocity in the arteries.
PAD or Venous Return
Ultrasound: To evaluate vein function, valve incompetence, and blood flow in the veins.
Venography: In some cases, a contrast dye is injected into the veins to visualize blood flow.
PAD:
Ankle-Brachial Index (ABI): A test that compares blood pressure in the ankle and arm to assess blood flow to the legs.
Doppler Ultrasound: Measures blood flow velocity in the arteries.
Venous Return Issues (CVI):
Ultrasound: To evaluate vein function, valve incompetence, and blood flow in the veins.
Venography: In some cases, a contrast dye is injected into the veins to visualize blood flow.
Treatment:
Lifestyle Changes: Smoking cessation, exercise, and a heart-healthy diet to improve circulation.
Medications: Statins, blood thinners (e.g., aspirin), and medications to manage risk factors like diabetes and hypertension.
Procedures: Angioplasty, stenting, or bypass surgery to restore blood flow in severe cases.
Amputation: In advanced cases, if gangrene or severe tissue damage occurs.
PAD
Treatment:
Lifestyle Changes: Elevating the legs, weight management, avoiding prolonged standing.
Compression Therapy: Compression stockings to help return blood to the heart and reduce swelling.
Medications: Diuretics for swelling, anti-inflammatory creams for stasis dermatitis.
Procedures: Sclerotherapy, laser therapy, or surgery to remove or close damaged veins.
Wound Care: For stasis ulcers, specialized dressings and possibly debridement.
Venous return
Complications:
PAD or Venous Return
Gangrene, critical limb ischemia, amputation, and increased risk of heart attack or stroke due to systemic vascular disease.
PAD or Venous Return Issues
Chronic ulcers, severe swelling, skin changes (stasis dermatitis), and infection of ulcers.
PAD:
Gangrene, critical limb ischemia, amputation, and increased risk of heart attack or stroke due to systemic vascular disease.
Venous Return Issues (CVI):
Chronic ulcers, severe swelling, skin changes (stasis dermatitis), and infection of ulcers.
PARIN
Is the suffix for which type of medication
Low molecular weight heparin
Enoxaparin / Lovenox
Dalteparin / Fragmin
Ardeparin / Normoflo
1st line of medication for HTN
Ace & Arbs
Renin Inhibitor Aliskiren
This major SE….
What to do if it happens…
Edema
Stop med
Take pt off HTN meds slow.
Esp BB
This can happen if taken off too quickly….
V Tach
PAD
Weak or Absent
This pulse…
Posterior tibial
PAD
Pallor….
Supine…
Pallor Supine / Elevated
Rubor Dependent
Ulcers
Top of toes upper foot…
Minor pain and ankle area
PAD or Venous Return
Top of toes / Upper foot PAD
Minor pain / Ankle area Venous Return
Aneurysms are measured how
Outside diameter…
Inside diameter….
At which size is surgery needed…
Outside CT
Inside US
Surgery >5 mm outside diameter
Aortic dissection is a life-threatening condition where a tear occurs in the ______ of the aorta
causing blood to flow between the layers of the vessel wall. This can lead to ______
intima (inner layer)
rupture, organ ischemia, or death if not treated immediately.
Sudden, severe “TEARING” or “RIPPING” chest/back pain
Type A: Pain in the chest, radiating to the back or neck.
Type B: Pain in the back, abdomen, or legs.
Hypertension (early) or hypotension (late, suggests rupture)
Unequal blood pressure in arms (>20 mmHg difference).
Pulse deficits (diminished or absent pulses).
Neurological symptoms (stroke-like symptoms if cerebral vessels are involved).
Aortic Dissection
Vena cava filter (IVC filter) is a small, cone-shaped metal device placed ____________ to trap blood clots traveling from the lower extremities before they reach the lungs, preventing pulmonary embolism (PE).
Inferior vena cava (IVC)
Indications for a Inferior Vena Cava Filter (4)
Recurrent or large pulmonary embolism (PE) despite anticoagulation.
Deep vein thrombosis (DVT) with contraindications to anticoagulation (e.g., recent hemorrhagic stroke, active bleeding, severe trauma).
High risk of PE (e.g., multiple trauma, recent major surgery, prolonged immobility).
Failure of anticoagulation therapy (recurrent DVT/PE despite treatment).
Dash Diet has this effect on N & K
Lower N
Increase K
STEMI
Time frame
Home - ER
ER - Cath lab
Cath lab - Procedure
30 min each
90 min total
Dosage of aspirin for Emergency Actue antiplatelet therapy…
Maintenance…
160 - 325 Chewed Not Swallowed
81 maintenance
How long min to take clopidogrel (Plavix) post cardiac Catheterization…
2 years
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (Savaysa)
Betrixaban (Bevyxxa)
This type of anticoagulants….
Factor Xa
Hold Nitroglycerin at this BP…
Limit BP drop to this….
Systole <90
20 - 30
Dropping BP too fast can have these consequences
Brain ischemia → Stroke, confusion, dizziness, or syncope.
Heart ischemia → Myocardial infarction (MI), angina, or arrhythmias.
Kidney injury → Acute kidney injury (AKI) due to reduced renal perfusion
Hypertensive Emergency (BP > 180/120 mmHg + End-Organ Damage)
Goal: Reduce MAP (Mean Arterial Pressure) by no more than 25% in the first hour.
Then: Reduce BP to…..
Gradual normalization over 24–48 hours to prevent ischemia.
Common IV Medications:
Nicardipine
Labetalol
Esmolol
Clevidipine
160/100 mmHg over 2–6 hours.
Heparin Appt time are checked….
Q6H min
Base metal & Drug Eluding Stents
Describe major differences in the Dual Antiplatelet therapy…
DAPT
Base Metal
Duration 1 month min.
Drug Eluding
3–6 months minimum (ideally 12 months)
Cardiac Rehab is run by RNs
21 - 24 sessions decrease risk of death by….
50%
Type of block that requires CAGB not stent..
Why…
Calcium
Its too hard
Anterior MI = ____ occlusion, high risk of heart failure & arrhythmias.
✔ ST-elevation in V1–V4, reciprocal ST depression in II, III, aVF.
✔ Reperfusion ASAP (PCI < 90 min or fibrinolysis < 30 min if PCI unavailable).
✔ Monitor for complications: heart failure, cardiogenic shock, aneurysm.
✔ Long-term management includes beta-blockers, ACE inhibitors, statins, and DAPT.
MOST FATAL
LAD
