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2021 Care and Management of Adults > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

formula for BP

A

BP = CO x PVR

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2
Q

PVR

A

peripheral vascular resistence

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3
Q

formula for CO

A

CO = SV x HR

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4
Q

SV

A

stroke volume

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5
Q

CO

A

cardiac output

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6
Q

normal BP

A

< 120 systolic

< 80 diastolic

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7
Q

What makes HTN the silent killer?

A

pts are asymptomatic while damage is done

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8
Q

HTN

A

> 120 systolic

> 80 diastolic

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9
Q

Tx for HTN is initialized at what values for pts ≥ and < 60 yo?

A
  • ≥ 60 yo: > 150/90
  • < 60 yo: > 140/90
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10
Q

categories of HTN

A
  • essential
  • secondary
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11
Q

etiology of essential HTN

A

not caused by pre-existing condition

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12
Q

etiology of secondary HTN

A

caused by pre-existing condition

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13
Q

gender-related HTN risk factors

A
  • < 45 yo: men > women
  • 45-65 yo: men = women
  • > 65 yo: men < women
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14
Q

nonmodifiable risk factors for essential HTN

A
  • > 60 yo
  • postmenopausal
  • family Hx
  • African-American race
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15
Q

modifiable risk factors for essential HTN

A
  • physical
    • overweight/obese
    • hyperlipidemia
  • diet: ↑ intake
    • Na+
    • caffeine
    • ETOH
  • lifestyle
    • inactivity
    • stress
    • nicotine use
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16
Q

risk factors for secondary HTN

A
  • kidney dz
  • primary aldosteronism
  • pheochromocytoma
  • Cushing’s
  • coarctation of the aorta
  • Brian tumors
  • encephalitis
  • PG
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17
Q

meds that increase risk of secondary HTN

A
  • estrogen
  • glucocorticoids
  • mineralocorticoids
  • sympathomimetics
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18
Q

continuous BP ↑ →

A

medial hyperplasia (thickening) of arterioles

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19
Q

↑ thickening of arterioles d/t BP →

A

↓ perfusion → end organ damage (heart, kidneys, brain)

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20
Q

damage from HTN →

A
  • MI
  • CVA
  • PVD
  • RF
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21
Q

MI

A

myocardial infarction

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22
Q

CVA

A

cerebrovascular accident

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23
Q

PVD

A

peripheral vascular dz

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24
Q

RF

A

renal failure

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25
Q

foods to improve HTN

A
  • veggies
  • fruits
  • whole grains
  • ↓ fat dairy products
  • poultry
  • fish
  • legumes
  • non-tropical oils
  • nuts
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26
Q

foods to limit to improve HTN

A
  • sweets
  • sugary beverages
  • red meat
  • dietary Na+
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27
Q

exercise to improve HTN

A

40 min 3-4x/wk

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28
Q

Na+ restriction to improve HTN

A
  • 2400 mg/day
  • preferred: 1500 mg/day
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29
Q

medications for HTN

A
  • diuretics
  • BBs
  • CCBs
  • ACE inhibitors
  • ARBs
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30
Q

CCB

A

Ca channel blocker

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31
Q

BB

A

beta blocker

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32
Q

ARB

A

angiotensin receptor blocker

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33
Q

ACE inhibitor

A

angiotensin-converting enzyme inhibitor

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34
Q

HTN urgencies

A
  • can be managed outpatient
  • managed w/ PO meds
  • can be acute or chronic
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35
Q

HTN emergencies

A
  • conditions w/ Sx of end organ damage
  • acute evolving Sx
  • expect ICU admission
  • IV meds to manage at first
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36
Q

medical emergencies that can be caused by HTN

A
  • acute CVA
  • AKF/AKI
  • CP, MI, ACS
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37
Q

ACS

A

acute cardiac syndrome

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38
Q

ARF

A

acute renal failure

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39
Q

ARI

A

acute renal injury

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40
Q

progression of CHD to HF

A

CAD → angina → MI → HF

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41
Q

stable angina characteristics

A
  • predictable
  • < 15 min
  • relief: rest, TNG
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42
Q

unstable angina characteristics

A
  • unpredictable
  • > 15 min
  • ↑ in occurence
  • No relief with rest, TNG
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43
Q

Sx of CAD

A

almost always none

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44
Q

MI characteristics

A
  • > 30 min
  • ↑ cardiac enzymes
  • requires immediate reperfusion therapy
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45
Q

types of MI

A
  • NSTEMI
  • STEMI
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46
Q

routine labs for suspected cardiac dz

A
  • enzymes
    • myoglobin
    • CK-MB
    • Troponin I or T
  • lipids
    • TC
    • HDL
    • LDL
    • triglycerides
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47
Q

meds for long-term MI Tx

A
  • ASA
  • BB
  • Ace inhibitors
  • ARBs
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48
Q

lifestyle/education for long-term MI Tx

A
  • ↑ activity
  • no nicotine
  • monitoring + Tx for
    • lipids
    • BP
  • diet: ↓ fat and Na+
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49
Q

HF long-term Tx meds

A
  • diuretics
  • antihypertensives
    • BBs
    • ACE inhibitors
    • ARBs
    • CCBs
  • possibly digoxin
  • anticoags
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50
Q

extra lab for HF

A

BNP

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51
Q

BNP

A

B-type natriuretic peptide

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52
Q

lifestyle/education for HF long-term Tx

A
  • everything for MI
      • Report SOB
      • Daily wt: report wt increase > 3 lbs/24 hrs
    • – lipid monitoring + Tx, unless indicated
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53
Q

arteriosclerosis

A

thickening/hardening of arterial walls

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54
Q

atherosclerosis

A
  • type of arteriosclerosis involving plaque formation on vessel walls
  • obstructs normal blood flow
  • stable or unstable
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55
Q

stable atherosclerosis

A

collagen ↓ likelihood of rupture

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56
Q

unstable atherosclerosis

A

rupture can cause more damage than in stable plaque rupture

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57
Q

atherosclerosis modifiable risk factors

A
  • dyslipidemia
  • lifestyle
    • nicotine
    • obesity
    • poor diet
    • inactivity
    • stress
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58
Q

nonmodifiable risk factors for atherosclerosis

A
  • genetic predisposition
  • ethnicity
    • African-American
    • Hispanic
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59
Q

assessment for atherosclerosis

A
  • CV assessment
  • echo/doppler flow studies
  • labs
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60
Q

CV assessment for atherosclerosis

A
  • NVD
  • extra heart sounds
  • peripheral pulses
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61
Q

lab values in atherosclerosis

A
  • ↓ HDL-C
  • ↑ LDL-C
  • ↑ triglycerides
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62
Q

interventions for CAD/atherosclerosis

A
  • change modifiable risk factors
  • lipid-lowering agents
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63
Q

groups for whom lipid-lowering meds are unsafe

A
  • liver
    • active dz
    • Hx of dz
    • unexplained ↑ LFTs
  • reproductive
    • current/possible PG
    • lactation
  • renal impairment
  • ETOH abuse
  • meds
    • digoxin
    • warfarin
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64
Q

PVD

A
  • peripheral vascular dz
  • umbrella term for
    • peripheral artery dz
    • peripheral venous dz (also PVD)
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65
Q

PAD

A

peripheral artery dz

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66
Q

peripheral artery dz incidence

A
  • most common type of PVD
  • legs > arms
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67
Q

etiology of PAD

A
  • systemic atherosclerosis
  • same risk factors
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68
Q

PAD characteristics

A
  • chronic
  • partial or total occlusion to affected extremities
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69
Q

inflow PAD obstruction location

A
  • ↑ inguinal ligament
  • arteries
    • distal aorta
    • common, internal, and external iliac arteries
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70
Q

inflow obstruction tissue damage

A

atypical

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71
Q

outflow obstruction location

A
  • arteries
    • femoral
    • popliteal
    • tibial
  • ↓ superficial femoral artery
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72
Q

outflow obstruction tissue damage

A

typical

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73
Q

PAD stages (4)

A
  • Stage I: asymptomatic
  • Stage II: claudication
  • Stage III: rest pain
  • Stage IV: gangrene/necrosis
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74
Q

inflow obstruction pain location

A
  • back
  • buttocks
  • thighs
75
Q

severity of inflow obstruction pain

A
  • mild: a couple of blocks
  • moderate: 1-2 blocks
  • severe: < 1 blocks, or at rest
76
Q

outflow obstruction pain description

A

burning, cramping

77
Q

outflow obstruction pain location

A
  • feet
  • toes
  • ankles
  • calves
78
Q

outflow obstruction pain relief

A

dangling feet off furniture

79
Q

outflow obstruction pain severity

A
  • mild: ~ 5 blocks
  • moderate: ~ 2 blocks + maybe intermittent at rest
  • severe:
80
Q

PAD findings are dependent on the _____ of the dz.

A

severity

81
Q

PAD assessment: inspection

A
  • hair loss on lower leg, foot
  • skin
    • dry, scaly, dusky, pale, mottled
    • pallor w/ elevation
    • severe dz: cold, cyanotic, darkened
    • darker-skinned pts: assess palms, soles
  • thickened toenails
82
Q

The _____ _____ pulse is best indicator of PAD.

A

posterior tibial

83
Q

PAD ulcer assessment

A
  • typically on or between toes, on foot
  • appearance
    • round w/ well-defined border
    • prolonged occlusion: gangrenous
84
Q

diagnostics for PAD

A
  • MRA
  • CTA
  • doppler
  • exercise tolerance
  • plethysmography
85
Q

MRA

A

magnetic resonance angiography

86
Q

CTA

A

computed tomography angiography

87
Q

doppler flow studies for PAD

A
  • assess segmental systolic BP
  • location: thigh, calf, ankle
  • values
    • normal: > brachial
    • PAD: < brachial
88
Q

exercise tolerance test for PAD

A
  • chemical or treadmill
  • get resting pulse folume
  • induce Sx, repeat pulse volume
  • diagnostic
    • ↓ ankle pressure (40-60 mm Hg)
    • delayed return to normal > 10 min
89
Q

plethysmography

A
  • waveform tracing of blood flow
  • flattened waves = occlusion
90
Q

inflow obstruction diagnostics

A
  • thigh-level BP < brachial
  • indicates severity
    • mild: 10-30 mm Hg difference
    • severe: 40-50+ mm Hg difference
91
Q

outflow obstruction diagnostics

A
  • diagnostic: ABI < 0.90 in either leg
  • normal: ankle pressure ≥ brachial pressure
92
Q

ABI

A

ankle-brachial index

93
Q

ABI formula

A

ankle BP ÷ brachial BP = ABI

94
Q

PAD nonsurgical management

A
  • exercise: promotes development of collateral circulation
  • positioning: controversial
  • promoting vasodilation
  • preventing vasoconstriction
95
Q

exercise guidelines for PAD management

A
  • gradually ↑ walking
  • walk until claudication, rest, walk farther
  • ↑ in amount of walking over time
  • not for
    • venous ulcers
    • severe rest pain
    • gangrene
96
Q

guidelines on positioning for PAD

A
  • extremities NOT above heart
  • hang feet or sit upright
  • don’t cross legs
  • no restrictive clothing
97
Q

promoting vasodilation for PAD management

A
  • encourage warmth w/ socks, shoes, covering
  • avoid heating pads d/t ↓ sensation
98
Q

preventing vasoconstriction for PAD management

A
  • avoid
    • cold/exposure
    • emotional stress
    • caffeine
    • nicotine
99
Q

PAD meds

A
  • hemorheologic agents
  • antiplatelets
  • antihypertensives (careful w/ BBs)
  • lipid-lowering agents
100
Q

antiplatelets for PAD Tx

A
  • ASA
  • clopidogrel
101
Q

hemorheologic agent action

A

↓ blood viscosity

102
Q

less invasive Tx for PAD

A
  • percutaneous vascular intervention
  • artherectomy
103
Q

percutaneous vascular intervention

A
  • arterial entrance through groin
  • balloon catheter inserted, stents placed
  • common or external iliac arteries typical
104
Q

artherectomy

A
  • device scrapes walls of vessel to remove plaque
  • used in popliteal artery or ↓
105
Q

PAD surgical management

A
  • arterial revascularization
  • bypass occluded area w/ autografted vessel
106
Q

indications for arterial revascularization

A
  • severe rest pain
  • claudication
  • interference w/ life
107
Q

veins used in arterial revascularization

A
  • preferred: saphenous vein (if not needed for CAD bypass)
  • alternates: cephalic or basilic vein
  • synthetic material
108
Q

inflow obstruction surgery

A
  • bypasses occlusion above superficial femoral arteries
  • indicated for
    • aortoiliac
    • aortofemoral
    • axillofemoral
  • less chance of reocclusion or post-op ischemia
109
Q

outflow obstruction surgery

A
  • bypass at or blow SFAs
  • indicated for
    • femoropopliteal
    • femorotibial
  • less successful in relieving pain
  • higher chance of reocclusion
110
Q

pre-op PAD care

A
  • baseline vascular assessment data
  • IV access
  • prophylaxis abx
111
Q

post-op PAD care

A
  • incentive spirometry
  • vascular assessments
    • X marks the spot
    • doppler pulses
    • BP monitoring
  • NPO
  • limited ROM
112
Q

PAD graft occlusion

A
  • post-op emergency
  • severe, continuous, aching pain
  • thorough pain assessment
  • extremity appearance (compare bilat.)
  • possible Tx
    • thrombectomy
    • tPA, other antiplatelets
  • watch for infection
113
Q

home management of PAD

A
  • promote vasodilation
  • ID S/Sx of infection
  • home health, case manager?
  • nicotine cessation
  • ↓ dietary fat intake
  • Rx tasks
    • exercise
    • meds
    • etc.
  • proper foot care
114
Q

acute PAD

A
  • S/Sx
  • sudden onset
  • likely embolus, more common in LE
  • pain even at rest
  • cool, mottled, cold, pulseless
  • untreated: necrosis or gangrene
  • Hx: often pts w/ recent MI, a-fib
115
Q

care of acute PAD

A
  • assess 6 Ps
  • maybe thrombectomy/embolectomy
  • tPA
  • risk for reocclusion
116
Q

types of peripheral venous disease

A
  • venous thromboembolism
  • venous insufficiency
  • varicose veins
117
Q

function of veins

A

carry deoxygenated blood back to heart

118
Q

structures that assist w/ venous function

A
  • valves
  • skeletal muscle
119
Q

types of venous thromboembolism

A
  • PE
  • DVT
120
Q

PE

A

pulmonary embolism

121
Q

DVT

A

deep vein thrombosis

122
Q

VTE

A

venous thromboembolism

123
Q

defective venous valves →

A
  • venous insufficiency
  • varicose veins
124
Q

Virchow’s triad

A
  • endothelial injury
  • venous stasis
  • hypercoagulability
125
Q

types of thrombus

A
  • phlebothrombosis
  • thrombophlebitis
  • deep vein thrombophlebitis
126
Q

phlebothrombosis

A

thrombus w/out inflammation

127
Q

thrombophlebitis

A

thrombus w/ inflammation

128
Q

deep vein thrombophlebitis

A
  • thrombosis: forms in deep vein
  • thromboembolism: breaks off and travels to deep vein
  • thrombophlebitis: thrombosis w/ inflammation
129
Q

VTE etiology

A
  • Virchow’s triad
  • surgery
  • medical conditions
  • immobility
  • IV placement
130
Q

DVT signs

A
  • localized tenderness along deep venous system
  • unilateral
    • swelling of entire leg
    • calf swelling > 3 cm
    • pitting edema
    • dilated superficial veins
  • previous DVT
131
Q

VTE risk factors

A
  • Virchow’s triad
  • hip surgery
  • TKA
  • HF
  • immobility
  • PG
  • oral contraceptives
  • active CA
132
Q

DVT diagnostics

A
  • imaging
    • duplex US
    • doppler flow study
    • MRI
  • lab: D-dimer
133
Q

D-dimer

A

blood test to detect product of clot breakdown

134
Q

nursing interventions for existing DVT

A
  • prevent complications
    • PE
    • venous insufficiency
    • post-thrombotic syndrome
  • education
    • current DVT
    • prevention of future DVTs
135
Q

DVT prevention nursing interventions

A
  • ambulation
  • hydration
  • compression
    • stockings
    • SCDs
  • anticoagulants
  • elevation
136
Q

compressing stockings guidelines

A
  • must wear for extended period
  • measure and use correct size, adjusting for wt changes
  • DO NOT massage extremity
  • assess
    • skin
    • 6 Ps
    • cap refill
137
Q

heparin therapy admin for DVT

A
  • IV infusion
  • prevents new clots
  • body breaks down existing clot
  • check labs before admin
138
Q

labs for heparin therapy

A
  • aPTT: 1.5-2x normal
  • PT/INR
  • CBC
  • UA
  • FOBT
  • Cr
139
Q

safety measures for heparin therapy

A
  • reliable IV pump
  • assessment
    • reach/maintain therapeutic aPTT
    • watch for S/Sx of
      • bleeding
      • HIT
  • antidote: protamine
140
Q

S/Sx of bleeding to watch for during heparin therapy

A
  • bruising
  • petechiae
  • melena
  • hematemesis
  • hematoma
141
Q

therapeutic aPTT for heparin therapy

A
  • 1.5-2x normal
  • notify provider if > 70 sec
142
Q

HIT

A

heparin-induced thrombocytopenia

143
Q

heparin-induced thrombocytopenia

A
  • immune rxn to heparin → widespread clotting
  • life-threatening
  • occurs w/ prolonged therapy
144
Q

prevention of HIT

A
  • LMWH
    • more commonly used
    • ↓ complications
145
Q

warfarin therapy for DVT

A
  • may be added to regimen for home use
  • inhibits synthesis of clotting factors in liver
  • pt education
    • will need regular labs
    • watch for S/Sx of bleeding
    • prevent injuries
    • keep antidote on hand
  • antidote: vitamin K
146
Q

PT/INR values for warfarin therapy after DVT

A
  • INR of 1.5-2 for prevention
  • 3.5-4 for pts w/
    • CV conditions
    • PE
    • risk for CVA
147
Q

inferior vena cava filtration nursing care

A

monitor for bleeding or infection at insertion site

148
Q

DVT self-management education

A
  • self-injection of LMWH
  • med compliance
  • follow-up and monitoring needs
  • dietary strategies
  • bleeding, bruising, and how to avoid
  • drug interactions
  • keep antidote on hand
149
Q

venous insufficiency patho

A
  • prolonged venous HTN
    • stretches veins
    • damages valves
  • → blood backup, stasis
  • → ↓ perfusion
  • → edema
  • → ulcers
  • → cellulitis
150
Q

venous insufficiency risk factors

A
  • sitting or standing for long periods
  • obesity
  • PG
  • thrombophlebitis
151
Q

venous insufficiency interventions

A
  • promote venous return
  • ↓ edema
  • heal ulcers
  • treat or prevent infection
  • prevent ulcer recurrence
152
Q

venous ulcer care

A
  • topical Tx
    • hydrocolloid dressing
    • artificial or cultured epithelial autografts
    • unna boot
    • chemical debridement
  • surgical: debridement; other surgeries not effective
153
Q

varicose vein patho

A
  • distended, tortuous veins
  • weakened vessel walls dilate
  • valves become incompetent
  • advanced dz →
    • insufficiency
    • edema
    • ulcers
154
Q

varicose vein risk factors

A
  • female
  • > 30 yo + prolonged standing
  • systemic dz
    • HD
    • DM
    • HTN
    • obesity
  • PG
  • family Hx
155
Q

types of aneurysms

A
  • fusiform
  • saccular
  • true
  • false
  • dissecting
156
Q

aneurysm

A

permanent, localized dilation of artery ≥ 2x original size

157
Q

aneurysm patho

A
  • tunica media weakens, stretching intima and externa
  • continued stretching + ↑ tension →
    • ↑ size of aneurysm
    • risk for rupture
    • HTN → ↑
      • rate of enlargement
      • risk for rupture
158
Q

fusiform aneurysm

A

entire artery circumference affected

159
Q

saccular aneurysm

A

outpouching affecting only distinct area

160
Q

true aneurysm

A

arterial wall weakened by congenital or acquired causes

161
Q

false aneurysm

A

vessel injury or trauma to all vessel wall layers

162
Q

dissecting aneurysm

A

formed when blood accumulates in artery walls

163
Q

typical aneurysm locations

A
  • most common: AAA
  • less common: TAA
164
Q

AAA

A

abd aortic aneurysm

165
Q

abd aortic aneurysm

A
  • most common aneurysm location
  • rarely symptomatic until emergent
  • often between bifurcation and renal arteries
166
Q

TAA

A

thoracic aortic aneurysm

167
Q

thoracic aortic aneurysm

A
  • less common than AAA
  • often missed or misdiagnosed
  • typically in ascending, descending, or transverse aorta
168
Q

aneurysm risk factors

A
  • nonmodifiable
    • age
    • gender
    • family Hx
  • modifiable
    • atherosclerosis
    • HTN
    • hyperlipidemia
    • nicotine
169
Q

AAA assessment

A
  • pain
    • sites: abd, back, flank
    • steady, gnawing
    • duration: hrs or days
  • pulsation in upper abd
  • DO NOT PALPATE
  • auscultate for aortic bruits
170
Q

TAA assessment

A
  • back pain
  • compression of aorta
    • SOB
    • hoarseness
    • difficulty swallowing
  • possible visible mass above suprasternal notch
171
Q

aneurysm rupture

A
  • EMERGENT
  • critically ill pts
  • TAA: sudden, excruciating chest or back pain
  • loss of pulses distally
  • retroperitoneal: flank hematoma
  • peritoneal: distended abd
  • risk for hypovolemic shock
    • hypotension
    • diaphoresis
    • ↓ LOC
    • oliguria
172
Q

nonsurgical aneurysm management

A
  • antihypertensives
    • maintain BP
    • ↓ rate of enlargement, risk for early rupture
  • if small, asymptomatic: frequent CT or US
  • pts need to follow up as scheduled
  • will be treated nonsurgically as long as possible
173
Q

surgical management of aneurysm

A
  • rupture = surgical emergency
  • Tx of choice
    • endovascular stent grafts
    • percutaneous insertion
174
Q

aneurysm post-op care

A
  • close monitoring
    • for graft occlusion
    • VS
    • pulses distal to graft
    • surgical site
    • pain level
  • HTN meds
  • HOB < 45˚ to prevent graft flexion
175
Q

post-op aneurysm home care

A
  • BSC
  • limited activity
  • no heavy lifting: < 15 lbs. x 6-12 wks
  • compliance w/ follow-ups
  • HTN meds
  • S/Sx of rupture
176
Q

assessment of popliteal or femoral aneurysm

A
  • may be associated w/ aneurysm elsewhere
  • pulsating mass at site
  • DO NOT PALPATE
  • S/Sx
    • ischemia
    • ↓ pulses
    • cool or cold skin
    • pain
177
Q

Tx of popliteal or femoral aneurysm

A
  • femoral: often uses autogenous saphenous vein graft w/ aneurysm removal
  • popliteal: usually bypass
178
Q

post-op care of popliteal or femoral aneurysm repair

A
  • pulses below site as ordered: X + doppler
  • monitor
    • 6 Ps
    • VS
      • hypotension: clot
      • HTN: bleeding
    • pain level: sudden change = occlusion
  • limit bending extremity
179
Q

aortic dissection

A
  • uncommon
  • life-threatening
  • patho: sudden tear in intima maybe d/t degeneration of media
  • locations
    • more common: ascending and descending thoracic
    • any major artery from aorta
180
Q

aortic dissection assessment

A
  • pain
    • 10/10
    • “ripping”
    • “tearing”
  • diaphoresis
  • N/V
  • apprehension
  • faintness
  • BP
    • imminent: HTN
    • rupture/tamponade: hypotension
  • weak/absent distal pulses
181
Q

aortic dissection interventions

A
  • large-bore IVs x2
  • ↓ BP: BB + nicardipine
  • IV fluids
  • foley to monitor renal fxn
  • long-term: SBP ≤ 130-140
182
Q

CV conditions ASA is used for

A
  • MI
    • long-term Tx
    • CP emergency Tx (MONA)
  • PAD maintenance
183
Q

CV conditions requiring heparin therapy

A
  • thrombus formation
  • high risk for thrombus formation
184
Q

when is warfarin used?

A

home therapy for those at high risk of thromboembolic d/o or with a history of such d/o

2021 Care and Management of Adults (3 decks)

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