Vascular Disease Flashcards
Prevention of HTN
- Limit sodium to 2400 mg/ day (1500 is better)
- Diet of fruits, veggies and whole grains
- limit sweets
- low fat dairy products, poultry, fish, legumes
- physical activity 3-4 times a week for 40 min
- limit alcohol consumption
Management of HTN
Lifestyle modifications:
- Diet
- Low sodium, low fat diet.
- Lower cholesterol levels to
Medication for HTN
- Diuretics
-Thiazide diuretics first choice for uncomplicated HTN. - Calcium channel blockers
-Verapamil, amlodipine - ACE inhibitors
-captopril, lisinopril, enalapril - Beta-adrenergic blockers
atenolol, metoprolol - Angiotensin II receptor antagonists (ARB)
-valsartan, losartan - Central alpha agonists
-clonidine - Alpha-adrenergic agonists
-prazosin, terazosin - Aldosterone receptor antagonists
-Eplerenone
Education for HTN
Teach Patient to: -Monitoring BP at home ---Goal of 140/90 or lower ---Keep a record and bring to visits with provider -Watch for Warning signs: ---MI, CVA, PAD, Kidney disease Take Medications Teach What meds are for and the side effects Teach Adherence to medication regimen
Symptoms of Peripheral Artery Disease
-Intermittent claudication
pain at rest, numbness and burning.
-Lower back or buttocks discomfort if inflow
-burning or cramping in calves, ankles feet or toes if outflow
-hair loss and dry scaly, pale or mottled skin, thick toenails
Treatment of Peripheral Artery Disease
Non-surgical:
exercise, positioning, promoting vasodilation, drug therapy, and invasive nonsurgical procedures to increase arterial flow in affected leg.
Surgical:
Arterial revascularization
Surgical bypassing occlusions
Education for Peripheral Artery Disease
Avoid crossing legs and avoid restrictive clothing which interfere with blood flow.
Check Feet daily for color or other changes.
VTE symptoms
- calf or groin tenderness
- pain and sudden onset of unilateral swelling of the leg
- pain in the calf on dorsiflexion of the foot
- palpate for induration, redness and warmth
Initial Treatment of VTE
-first focus is preventing complications such as PE, prevent further thrombus formation and prevent the one you have enlarging
Management of VTE
- drug therapy and rest
- Anticoagulants
What is Peripheral Artery Disease
Alters natural flow of blood through arteries and veins of peripheral circulation
Result of systemic atherosclerosis
What is Peripheral Venous Disease
-VTE basically
What is HTN
High blood pressure
150/90 if you are over 60
140/90 if you are under 60
This excludes pts w diabetes mellitus.
What is buergers disease
-thromboanginitis obliterans—relatively uncommon occlusive disease of arteries and veins in distal portion of upper and lower extremities
Often identified with tobacco smoking
Familial or genetic predisposition and autoimmune etiologic factors also possible
What are symptoms of buergers disease
-Claudication Aching pain Sensitivity to cold Diminished pulses Cool, red, or cyanotic extremities
What is management of buergers disease
-Treatment focuses on prevention of disease progression
abstinence of tobacco in all forms
Avoid exposure to cold
Medications for vasodilation
What is aortic disease?
-
Abdominal aneurysm symptoms
-
Thoracic Aneurysm symptoms
–
Repair of aneurysm
-
Management of Aneurysm
-
What is raynaud’s phenomenon?
-Caused by vasospasm of arterioles and arteries of upper and lower extremities
What are symptoms of raynauds phenomenon?
-
How is Raynaud’s phenomenon managed?
-Drug therapy—nifedipine, cyclandelate, phenoxybenzamine
Lumbar sympathectomy
Restrict cold exposure
Reinforce patient education
What is VTE?
-Thrombus—a blood clot Thrombophlebitis Deep vein thrombosis (DVT) Pulmonary embolism Virchow’s triad -1.Stasis of blood flow -2.Endothelial injury -3,Hypercoagulability Phlebitis
What is the etiology of VTE?
-
How is VTE managed?
-Early ambulation Adequate hydration Compression stockings Intermittent pneumatic compression (SCDs) Venous flexus foot pump Anticoagulation
Severe Peripheral artery disease symptoms
- extremity is cold and gray-blue or darkened;
- pallor may occur with extremity elevation; -dependent rubor;
- and/or muscle atrophy
Statin education
- take it at night
- see physician regularly
Drugs for arteriosclerosis
lovastatin
simvastatin
gemfibrozil
ezetimibe
What to monitor with statins
liver enzymes
Diabetes pt normal BP
140/90
Go read slide 12 on the doc
Go read slide 12 on the doc
1st step of medication at the beginning with HTN =
thiazide diuretic
what is “end organ damage”
High BP for so long it damages other organs
Be able to asociate the name with the class of these drugs
Diuretics Thiazide diuretics first choice for uncomplicated HTN Calcium channel blockers Verapamil, amlodipine ACE inhibitors captopril, lisinopril, enalapril Beta-adrenergic blockers atenolol, metoprolol, Renin inhibitors aliskiren
Angiotensin II receptor antagonists valsartan, losartan Central alpha agonists clonidine Alpha-adrenergic agonists prazosin, terazosin Aldosterone receptor antagonists Eplerenone
In crisis how quickly do we lower BP?
We titrate so it drops slowly
Reduce by no more than 25% in first 2-6 hours
If stroke lower slowly 15-20%
Know what nitrates do:
-causes vasodilation (widening of blood vessels) by donation of nitric oxide (NO), and is mostly used for the treatment and prevention of angina pectoris.
Know nursing interventions for nitrates/ nitroprusside drip
- Tell them to stay in bed
- Teach them to call if they get up
- they can have headaches
- check BP q15 if no hemdynamic
- document the numbers
Know nicardipine drip and why we pick it
-nicardipine is neuroprotective
Ankle brachial index (ABI)
take the blood pressure in the brachial area and the ankle
compartment syndrome
A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues.
6 P’s of arterial insufficiency
Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia (coolness)
aortic aneurysm (fusiform)
protruding on both sides
aortic aneurysm (sacular)
one side
false aneurysm
due to trauma or vessel injury
true aneurysm
weakened from congenital problems
aneurysm symptoms
limb ischemia, diminished or absent pulses, cool to cold skin, pain
abdominal aortic aneurysm
usually steady with a gnawing quality, unaffected by movement, may last for hours or days
Pain in abdomen, flank, back
bruit
rupture of AAA
signs of hypovolemic shock
-Sudden ripping, tearing, stabbing abdominal or back pain and legs.
-Diaphoresis, faintness, N&V, apprehension
Hypotension, tachycardia
symptoms of thoracic A
THINK HOARSENESS -coughing and wheezing Horner's syndrome (drooping eyelid, constricted pupil and dry skin on one side of the face) Hoarse voice Difficulty swallowing
Back pain
Mass may be visible above suprasternal notch
rupture of thoracic A
-Sudden excruciating back or chest pain symptomatic of thoracic rupture. Pain can travel into arms, abdomen and lower back
Management of Raynaud’s disease
Drug therapy
Restrict cold exposure
Reinforce patient edu
what is virchow’s triad
- 1.Stasis of blood flow
- 2.Endothelial injury
- 3,Hypercoagulability
Who is at risk for VTE?
Hip surgery Total knee replacement Open prostate surgery Ulcerative colitis Heart failure Cancer Oral contraceptives Immobility Obesity Age > 60
D Dimer
a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrin protein.
VTE nonsurgical management
Unfractionated heparin
Low–molecular weight heparin
Warfarin
Thrombolytics
unfractionated heparin drip
titrate based on labs
-ptt
understand overlap of heparin drip and warfarin
DVT - for immediate coagulation start heparin
Warfarin takes longer (if i start warfarin today i wont go home tomorrow)
2-5 days = theraputic
VTE pathology
When a thrombus develops, inflammation occurs around the clot. thickening the vein wall and leading to the formation of an embolus (pulmonary embolus being the most common).
unfractionated heparin therapy
inhibition of fibrin formation
for pts with a confirmed dx of clot
management of thoracic aneurysm
non-surgical:
Monitor aneurysm growth
Maintain BP at normal level to decrease risk of rupture
aortic dissection:
- caused by
- creates
- pain described as
Caused by: sudden tear in aortic intima, opening way for blood to enter aortic wall
Creates a false lumen
Pain described as tearing, ripping, stabbing
What is Raynaud’s
Caused by vasospasm of arterioles and arteries of upper and lower extremities
drugs for raynauds
nifedipine, cyclandelate, phenoxybenzamine
saccular aortic aneurysm
an outpouching only affecting a portion of the artery
