Test 2 Vascular Problems Flashcards

1
Q

High Blood Pressure is most common in this group…

Is this trend going down year-by-year

A

Black females 42.9 %
Black Male 40.3%

The trend is increasing in High Blood Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Blood Pressure Categories

Normal

Elevated

HTN Stage 1

HTN Stage 2

Hypertensive Crisis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Blood Pressure

120- 129 / <80

A

Elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define BP

130 - 139 / 80 - 89

A

HTN Stage 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define blood pressure

> 140 / OR > 90

A

HTN Stage 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define blood pressure

> 180 and /or >120

A

Hypertensive Crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define “Resistant” HTN

A

Elevated despite treatment with 3 or more antihypertensive meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

HTN Urgency Define reading…

HTN Emergency Define reading…

A

> 180 & or >120

> 180 + Target organ damage & or >120 + Target organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

BP control systems

Define how they work

Arterial baroreceptors…..

Renal blood flow….

RAAS…..

Vascular Auto-Regulation….

A

Arterial baroreceptors (Sense Pressure)

Renal blood flow (Retention or Diuresis)

RAAS (Na & H²O Retention)

Vascular Auto-Regulation (Auto-Regulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cause of Essential HTN…

Cause of Secondary HTN…

A

Essential: No known cause

Secondary:

Diseases (Kidney/adrenal, Aortic Narrow, Brain, Obstructive Sleep Apnea)

Meds: Estrogen, Steroids, Sympathetic

Food (High Cholesterol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chlorothiazide
Chlorothalidone
Hydrochlorothiazide
Metolazone

Tyoe of med…

Action….

Avoid with these health issues…

Teaching….

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Furosemide
Bumetanide
Torsemide
Ethacrynic Acid

Examples of which med…

A

Loop Diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Amiloride
Eplerenone
Spironolactone
Triamterene

Type of medication….

A

K sparing Diuretucs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Amlodipine
Felodipine
Nicardipine

What is special about these CCBs

A

Dihydropyridines (DHPs):

Used to control HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 3 CCB that are used to control HTN

A

Dihydropyridines

Amlodipine
Felodipine
Nicardipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Verify K levels before giving which meds. SATA

Hydrochlorothiazide
Furosemide
Spironolactone
Lisinopril

A

All the above

(Prevent Hypokalemia)
Hydrochlorothiazide
Furosemide

(Prevent Hyperkalemia)
Spironolactone
Lisinopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ACE Inhibitors Prevent conversion of angiotensin I to angiotensin II in the lungs. This can cause..

A

Unrelating cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Alpha blockers

Prazosin
Doxazosin
Terazosin

(3) affects beside lower BP

Give (3)

A

Lower LDL
Increase sensitivity to insulin
Prevents vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Central Alpha Blockers (Lower BP)

Methyldopa
Clonidine

SE….

A

Somnolence & Dry mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Central alpha blockers (Lower BP)

SE: Somnolence & Dry mouth

Give 2 examples….

A

Methyldopa
Clonidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hydralazine
Minoxidil
Nitroprusside

Type of medications….

Action…..

A

Direct Vasodilators

Action: Vasodilates arterial smooth muscle

Hydralazine
Minoxidil
Nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Direct Vasodilators

Hydralazine
Minoxidil
Nitroprusside

*Start Low & slow increase dose

SE: (4)

Use:

A

SE

Reflex Tachycardia
Orthostatic hypotension
Headache
Facial Flushing

Use: Lower BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Direct Renin Inhibitor

Aliskiren

Action….

A

Inhibits Renin to lower BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Aliskiren

Action: Inhibits Renin in blood stream to lower BP

Class….

A

Direct Renin Inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
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
26
Intermittent claudication.... Define
Leg pain with activity that improves with rest.
27
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
28
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
29
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
30
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
31
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
32
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
33
Testing for PAD Blood flow to the extremities should decrease immediately after exercise T or F
F Should increas
34
Plethysmography...
Measures amount of blood or air in a part of the body. Used to determine PAD
35
Pentoxifylline Action.... Use...
Action: reducing blood viscosity and improving microcirculation Use: improves blood flow
36
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.
37
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)
38
Femoral popliteal bypass is used for these disease...
peripheral arterial disease (PAD) or severe leg ischemia.
39
Acute Arterial Occlusion Manifestación: 6 Ps of ischemia
Pain Pulseless Paralysis Pallor Paresthesia Poikilothermia (body temperature that fluctuates with the surrounding environment)
40
Acute Arterial Occlusion Pain Pulseless Paralysis Pallor Paresthesia Poikilothermia (body temperature that fluctuates with the surrounding environment) Treatment....
Heparin Thrombolytics Embolectomy
41
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
42
Bypass graft quality surveillance (2)
ABI & Duplex Doppler
43
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
44
Permanent localized dilation of an artery
Aneurysms
45
Causes of Aneurysms (Permanent localized dilation of an artery) (4)
Atherosclerosis Syphilis Marfan syndrome HTN
46
Class most at risk for Aneurysms
Men >65 History of smoking >100 ciggys
47
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
48
Endovascular Aneurysm Repair (EVAR), Abdominal Aortic Aneurysm (AAA) Resection, Thoracic Aortic Repair
Surgical management of aneurysms Problem: Ineffective tissue Perfusion
49
Aortic dissection Sudden tear in ____ lining
Intimal
50
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
51
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
1. Is wrong elevated at 30 to 45 degrees (semi-Fowler’s position) unless contraindicated.
52
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)
53
Diuretics CCB ACE & ARB Alpha blockers Central Alpha Blockers Beta Blockers Adrenergic Blockers Direct Vasodilators Direct Renin Inhibitor For which problem...
HTN
54
Medications for HTN (8)
Diuretics CCB ACE & ARB Alpha blockers Central Alpha Blockers Beta Blockers Adrenergic Blockers Direct Vasodilators Direct Renin Inhibitor
55
Amlodipine Felodipine Nicardipine CCB used for treatment of HTN What is the primary use of CCB....
Non-ventricular tachycardia or Angina treatment
56
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.
57
ACE Inhibitors cause (Arterial or Venous) Vasodilation; Decreasing SVR.
Both Arterial & Venous Vasodilation to Decrease SVR
58
Prevent reuptake of norepinephrine in vascular smooth muscle to prevent vasoconstriction. Class... Examples...
Alpha Blockers Prazosin Doxazosin Terazosin
59
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
60
Blocks sympathetic activity in the brainstem to reduce outflow to the heart and blood vessels. Class... Examples...
Central Alpha Blockers Methyldopa Clonidine
61
Give example of the Only Direct Renin Inhibitor discussed...
Aliskiren
62
Peripheral perfusion drugs Aspirin Clopidogrel Cilostazol..... Pentoxifylline.... Describe....
Cilostazol: Vasodilator Pentoxifylline: Increases RBC flexibility
63
Legs swollen, tight, pale and shiny. Swollen muscle compresses blood vessels and nerves in the extremity. Name condition...
Compartment syndrome
64
Where will a thoracic aneurysm be located...
Above sternal knotch
65
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.
66
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
67
Describe Virchows Triad...
Endothelial injury Venous Statis Hypercoagability
68
Risk Factors Surgery (Hip,Knee, Prostate) Immobility Phebilitis Cancer UC HF Oral contraceptives
Venous Thromboembolism
69
For venous thromboembolism Leg in this posistion...
Elevated to return blood to heart
70
Diagnosis for venous thromboembolism
D-dimer Venous US
71
Give this med for home therapy for stable DVT / PE
Enoxaparin / Lovenox Dalteparin / Fragmin Ardeparin / Normoflo Low Molecular Weight Heparin
72
Enoxaparin / Lovenox Dalteparin / Fragmin Ardeparin / Normoflo Class of med... Use...
Low molecular weight heparin Home therapy for DVT & PE
73
How long for Warfarin to reach therapeutic level...
3 or 4 days
74
Quickly Disolve thrombi and prevent venous insufficiency Class... Contradictions...
Thrombolytics Contradictions Post-op Preggers Trauma / Bleeding Stroke
75
Causes of Venous Insufficiency (4)
Standing Sitting in 1 posistion prolonged Preggers Obesity (Throbosis or damaged valves cause blood back up)
76
RBC and waste products accumulation in tissues causing swelling, cellulitis, ulcers...
Venous insufficiency
77
Inflammation of the superficial vein caused by an irritant...
Phlebitis
78
Phlebitis Superficial vein inflammation caused by an irritant. Treatment...
Remove IV Warm compress
79
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.
80
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.
81
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.
82
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.
83
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
84
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
85
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.
86
PARIN Is the suffix for which type of medication
Low molecular weight heparin Enoxaparin / Lovenox Dalteparin / Fragmin Ardeparin / Normoflo
87
1st line of medication for HTN
Ace & Arbs
88
Renin Inhibitor Aliskiren This major SE.... What to do if it happens...
Edema Stop med
89
Take pt off HTN meds slow. Esp BB This can happen if taken off too quickly....
V Tach
90
PAD Weak or Absent This pulse...
Posterior tibial
91
PAD Pallor.... Supine...
Pallor Supine / Elevated Rubor Dependent
92
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
93
Aneurysms are measured how Outside diameter... Inside diameter.... At which size is surgery needed...
Outside CT Inside US Surgery >5 mm outside diameter
94
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.
95
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
96
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)
97
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).
98
Dash Diet has this effect on N & K
Lower N Increase K
99
STEMI Time frame Home - ER ER - Cath lab Cath lab - Procedure
30 min each 90 min total
100
Dosage of aspirin for Emergency Actue antiplatelet therapy... Maintenance...
160 - 325 Chewed Not Swallowed 81 maintenance
101
How long min to take clopidogrel (Plavix) post cardiac Catheterization...
2 years
102
Rivaroxaban (Xarelto) Apixaban (Eliquis) Edoxaban (Savaysa) Betrixaban (Bevyxxa) This type of anticoagulants....
Factor Xa
103
Hold Nitroglycerin at this BP... Limit BP drop to this....
Systole <90 20 - 30
104
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
105
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.
106
Heparin Appt time are checked....
Q6H min
107
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)
108
Cardiac Rehab is run by RNs 21 - 24 sessions decrease risk of death by....
50%
109
Type of block that requires CAGB not stent.. Why...
Calcium Its too hard
110
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