Vascular

Question 1

Classifications & Etiology of HTN - Primary (essential)

Answer 1

• Most common type
• Not caused by an existing hlth problem; can develop when a pt has any 1 or more risk factors:
  > family hx
  > African-American
  > hyperlipidemia
  > smoking
  > older than 60 or postmenopausal
  > excessive sodium & caffeine intake
  > overweight/obesity
  > physical inactivity
  > excessive alcohol intake
  > low potassium, calcium, or magnesium intake
  > excessive & continuous stress

Question 2

Classifications & Etiology of HTN - Secondary

Answer 2

• Results from specific diseases & some drugs
• Kidney disease is one of the most common causes of secondary HTN

Question 3

Phsyical Assessment of HTN

Answer 3

• Most ppl have no symps
• Some pts experience headaches, facial flushing, dizziness, fainting
• BP screenings:
  > take in both arms
  > 2 or more readings at a visit
  > use appropriate size cuff

Question 4

Orthostatic Hypotension

Answer 4

• Dcr in BP w/ changes in position
  > 20 mmHg for systolic and/or 10 mmHg for diastolic

Question 5

Psychosocial Assessment for HTN

Answer 5

Asseess for stressors tht can worsen HTN

Question 6

Diagnostic Assessment for HTN

Answer 6

• No specific testing for primary HTN
• Secondary HTN can be screen w/ labs specific to underlying disease
  > EX: kidney disease

Question 7

Interventions for HTN

Answer 7

• Lifestyle changes
  > dietary sodium restriction to less than 2g
  > reduce weight
  > use alcohol sparingly
  > exercise 3-4 days a week for 40mins
  > use relaxation techniques to dcr stress
  > avoid tobacco & caffeine
• Complementary & alternative therapies
  > biofeedback
  > meditation
• Drug therapy
• Avoid OTC meds (NSAIDs & decongestants)

Question 8

Drug Therapy for HTN

Diuretics

Answer 8

• 1st line of meds
• dcr blood volume & lower BP
• Hydrochlorothiazide
• Furosemide (Lasix)
• Torsemide (Demadex)
• Spironolactone (Aldactone)
• monitor for hypokalemia w/ thiazide & loop diuretics
• monitor for hyperkalemia w/ potassium-sparing
• educate abt frequent voiding
• monitor for dehydration & orthostatic hypotension

Question 9

Drug Therapy for HTN

calcium channel blockers

Answer 9

• Interferes w/ calcium ions causing vasodilation to lower BP
• Verapamil (Calan)
• Amlodipine (Norvasc)

Question 10

Drug Therapy for HTN

angiotensin-converting enzyme (ACE) inhibitors

Answer 10

• Blocks angiotension conversion which inhibits vascoconstriction
  > vasodilation occurs & BP is lowered
• Captopril (Capoten)
• Lisinopril (Prinivil, Zestril)
• Enalapril (Vasotec)
• Common side effect: nagging dry cough

Question 11

Drug Therapy for HTN

angiotensin II receptor blockers

Answer 11

• Blocks binding of angiotensin to receptor sites which inhibits vasoconstriction
  > vasodilation occurs & BP is lowered
• Candesartan (Atacand)
• Valsartan (Diovan)
• Losartan (Cozaar)
• Azilsartan (Edarbi)
• monitor for hyperkalemia

Question 12

Drug Therapy for HTN

aldosterone receptor antagonists

Answer 12

• Blocks binding of aldosterone at receptors which inhibits sodium reabsorption
• Eplerenone (Inspra)
• monitor for hyperkalemia
• can interact w/ many other drugs & grapefruit

Question 13

Drug Therapy for HTN

best-adrenergic blockers

Answer 13

• Drug of choice for hypertensive pts w/ ischemic heart disease
• Blocks beta receptors whcih dcr HR & myocardial contractility
• sympathetic nervous system is blocked
• Metoprolol (Toprol, Lopressor)
• Atenolol (Tenormin)
• Bisoprolol (Zebeta)
• monitor for orthostatic hypotension
• can cause fatigue, depression, & sexual dysfunction
• angioedema can be side effect
• use w/ caution in pts w/ DM bc glucose production may be affected

Question 14

Venous Thromboembolism Risk Factors

Answer 14

• Stasis of blood
• Vessel wall injury
• Altered blood coagulation

Question 15

VTE Prevention

Answer 15

• Pt education
• Leg exercises
• early ambulation
• adequate hydration
• graduated compression stocking
• intermittent pneumatic compression; SCDs
• venous plexus foot pump
• avoid oral contraceptives
• anticoagulant therapy

Question 16

Symptoms of DVT

Answer 16

• Classic S/S:
  > calf or groin tenderness/pain
  > sudden onset unilateral swelling of leg
• Induration (hardening) along blood vessel
• warmth, edema, redness
• checking a Homan’s sign isn ot advised
• physical exam

Question 17

Diagnostic Assessment for DVT

Answer 17

• Venous duplex ultrasonography
  > assesses flow of blood through veins of arms & legs

Question 18

Lab Testing for DVT

Answer 18

• Negative D-Dimer test can exclude DVT
  > used for diagnosis DVT when pt has few CMs

Question 19

DVT Interventions

Answer 19

• Goals: prevent pulmonary emboli, further thrombus formation, or an incr in size of thrombus
• Observe for symps of pulm emboli:
  > SOB, chest pain, acute confusion
• Elevate legs when in bed & chair
• Do not massage affected extremity
• Drug therapy:
  > Anticoags: Heparin, Enoxaparin (Lovenox), Warfarin (Coumadin)