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Nursing Across the Lifespan 1 (Exam 1 Prep) > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

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1
Q

What is the range for a normal Elevated Hypertension?

A

Systolic = 120-129 mmHg

Diastolic = < 80 mmHg

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2
Q

What range is Hypertension Stage 1?

A

Systolic = 130-139 mmHg

Diastolic = 80-89 mmHg

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3
Q

What range is Hypertension Stage 2?

A

Systolic = Greater than or equal to 140 mmHg

Diastolic = Greater than or equal to 90 mmHg

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4
Q

In order to stage hypertension, how many readings does there need to be?

A

2 or more elevated readings, on both arms, on 2 separate occasions

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5
Q

Are there Cultural or Gender differences with Hypertension?

A

Yes

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6
Q

What is the difference between Primary and Secondary Hypertension?

A

Primary has no cause
Secondary has a specific cause

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7
Q

Between men and women, which one has a greater risk of being Hypertensive from an earlier age?

A

Men

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8
Q

A person’s DBP will typically increase until what age?

A

55 Years Old

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9
Q

A person’s DBP will typically do what once they get 55 Years Old?

A

Start Declining

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10
Q

Between African Americans and White Americans, which one is more at risk of Hypertension?

A

African Americans

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11
Q

What is Prehypertension?

A

The stage between a Normal BP and Hypertension

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12
Q

What is considered to be the range for Prehypertension?

A

A SBP of 121 - 139 mmHg

A DBP of 81 - 89 mmHg

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13
Q

What are some of the older terms for Primary Hypertension?

A

Essential Hypertension + Essential Hypertension

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14
Q

Primary makes up what % of Hypertension cases of all Hypertension?

A

90 - 95%

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15
Q

Even though we don’t know the cause of Primary Hypertension, we do know the contributors, such as-

A

Increased Sodium Intake + Overweight + Diabetes mellitus + Excessive Alcohol

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16
Q

What are potential causes of Secondary Hypertension?

A

Pregnancy, Meds, Renal Disease, Estrogen Therapy, etc.

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17
Q

Risk factors for Primary Hypertension =

A

Age + Cigarette Smoking + Alcohol + Obesity + Excessive Sodium + Increased Triglycerides / Cholesterol + Sedentary Lifestyle + Stress + Diabetes mellitus + Family History + Ethnicity + Socioeconomic Status + Family History

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18
Q

What are the Clinical Manifestations of Hypertension?

A

Asymptomatic until Organ Damage (Due to the Heart’s increased workload)

Fatigue + Decreased Activity Tolerance + Dyspnea + Angina + Dizziness

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19
Q

What does Target Organ Damage (TOD) mean?

A

Damage to the body’s main organs (Heart, Brain, Kidneys, Eyes, etc.)

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20
Q

What are the symptoms of the TOD that occurs due to Hypertension?

A

Coronary Artery Disease (CAD) + Left Ventricular Hypertrophy (LVH) + Heart Failure + TIA’s & Strokes + Peripheral Vascular Disease (PVD) + Nepherosclerosis + Retinal Damage

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21
Q

What are the most common complications of Hypertension?

A

Target Organ Diseases

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22
Q

The exact mechanism of this disease is unknown, but it causes stiffened arterial walls with narrowed lumens. Leads to Angina and an MI =

A

Coronary Artery Disease

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23
Q

What is Left Ventricular Hypertrophy?

A

When an increased workload on the left ventricle causes it to become enlarged

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24
Q

This is what it’s called whenever the heart finally gives out. There’s decreased contractility, stroke volume, and CO =

A

Heart Failure

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25
Q

What is one thing that Atherosclerosis sped up by?

A

Hypertension

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26
Q

Atherosclerosis is the number 1 cause of-

A

Cerebrovascular Accident (CVA)

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27
Q

What’s a major risk of Atherosclerosis?

A

Hypertension

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28
Q

What’s the number 1 cause of a CVA occurring in Hypertensive pt’s?

A

Noncompliance to Meds

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29
Q

Why is a noncompliance with meds so common with Hypertension?

A

Hypertension can be asymptomatic until it’s a big issue, the meds for treatment do have side effects and are expensive

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30
Q

What’s a leading cause of End-Stage Kidney Disease?

A

Hypertension

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31
Q

What is Kidney Disease a direct result of?

A

Ischemia

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32
Q

How does Hypertension cause Ischemia?

A

By narrowing the Lumens of Arterioles

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33
Q

What does Kidney Disease result in?

A

Damaged Glomeruli and the death of Nephrons

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34
Q

What blood study results are a sign of Kidney Disease?

A

The presence of Microalbuminuria + Proteinuria + Elevated BUN/Creatine

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35
Q

This is commonly the first sign of Kidney Disease =

A

Nocturia

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36
Q

What’s the only place in the body that we can actually directly visualize the blood vessels?

A

The Retina

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37
Q

Damage here is a good indicator of damage in the vessels of the heart, etc. =

A

Retina

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38
Q

If Retinal damage has occurred, what symptoms may the pt have?

A

Blurred Vision OR Loss of Vision + Retinal Hemorrhage

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39
Q

What lifestyle modifications can help treat Hypertension?

A

Weight Reduction + Decrease Sodium Intake + Lower Alcohol Intake + Regular Physical Activity + Avoid Tobacco + Stress Management

Dietary Approaches to Stop Hypertension (DASH) eating plan

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40
Q

Losing 22 lbs can lower your BP by how much?

A

5-20 mmHg

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41
Q

What foods make up the DASH Plan?

A

Fish, Lots of Water, Increased Fiber, Fruits / Veggies

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42
Q

Sodium intake should be lowered to less than how many mg a day for a normal healthy person?

A

Under 2,300 mg a day

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43
Q

Sodium intake should be lowered to less than how many mg a day for a person with Diabetes mellitus, Chronic Kidney Disease, or Hypertension?

A

Under 1,500 mg a day

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44
Q

Excessive Ethanol (ETOH) is strongly associated with -

A

Hypertension

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45
Q

Men should have no more than how many alcoholic drinks in a day?

A

2

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46
Q

Women should have no more than how many alcoholic drinks in a day?

A

1

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47
Q

This is the most common cause of Secondary Hypertension in America =

A

Cirrhosis

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48
Q

How much exercise should a person get in a day? How often?

A

30 mins of an Aerobic Physical Activity (like brisk walking) once a day at least 5 days a week

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49
Q

What is White Coat Syndrome?

A

It’s when someone gets Hypertension whenever in a clinical setting, but their BP is normal when out of a clinical setting

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50
Q

What should you tell a person with White Coat Syndrome to do?

A

Check their BP at home (If unable to do this, then do Ambulatory BP Monitoring instead)

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51
Q

When is your BP the highest?

A

The Early Morning

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52
Q

When does your BP decrease?

A

It decreases throughout the day

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53
Q

When is your BP at its lowest?

A

At Night

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54
Q

What is the goal BP range for a patient to be under for those without Diabetes or Kidney Disease?

A

Under 140/90 mmHg

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55
Q

What is the goal BP number for a patient to be under for those with Diabetes or Kidney Disease?

A

130/80 mmHg

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56
Q

What meds are used to treat Prehypertension?

A

Meds aren’t used to treat Prehypertension

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57
Q

Fish Oil Supplements and Herbal Therapy can-

A

Lower Hypertension

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58
Q

What’s one of the most common side effects of Anti-Hypertensive Meds?

A

Postural Hypotension

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59
Q

What is Postural Hypotension?

A

You may feel Dizzy, Weak, or Faint when first sitting up or when standing

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60
Q

How can you diagnose Postural Hypotension?

A

Obtain BP when Lying Down + Sitting + Standing

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61
Q

What indicators can show if a pt has Postural Hypotension?

A

Decreased SBP of 20 mmHg on Standing.

Decreased DBP of 10 mmHg on Standing.

Increased HR of 20 BPM from Supine to Standing.

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62
Q

Sexual Dysfunction (Decreased Libido + ED) can be caused by-

A

Hypertensive Meds

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63
Q

Most hypertensive pt’s will require how many Antihypertensive Meds?

A

More than 2

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64
Q

Are Forearm and Upper Arm BP’s interchangeable?

A

No (Site should be documented)

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65
Q

When taking a pt’s BP, don’t forget to take it on the same level as the-

A

Heart

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66
Q

If a pt is lying Supine, what should you do before taking the pt’s BP?

A

Raise and support their arm with a small pillow

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67
Q

When taking a hypertensive pt’s BP, which arm should you take their BP on at first? What next?

A

Both arms at first.

Whichever arm that has the highest reading should have at least 2 readings, each reading being 1 min apart.

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68
Q

If you can’t use a pt’s upper arm for a BP reading, what other site should you try as a secondary option?

A

Use the Forearm over the Radial Artery

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69
Q

What is Resistant Hypertension?

A

Stubborn HTN that refuses to lower after taking Hypertensive Meds

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70
Q

How is Resistant Hypertension treated?

A

A 3 Drug Regimen (Includes a Diuretic)

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71
Q

What are some causes of Resistant Hypertension?

A

Volume Retention + Drug Induced + Associated Conditions

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72
Q

What drugs can cause Resistant Hypertension =

A

NSAID’s + Corticosteroids + Decongestants

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73
Q

Associated conditions of Resistant Hypertension =

A

Obstructive Sleep Apnea + Primary Aldosterone + CKD

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74
Q

What is a Hypertensive Crisis?

A

An abrupt rise in SBP that’s greater than 180 mmHg
OR
An abrupt rise in DBP that’s greater than 120 mmHg

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75
Q

How high can a Hypertensive Crisis BP get up to?

A

220/140 mmHg

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76
Q

How is the severity of Hypertensive Crisis measured?

A

By the rate of the rise in BP

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77
Q

Most common cause of Hypertensive Crisis =

A

Noncompliance to meds

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78
Q

What is the goal in a pt with Hypertensive Crisis?

A

Avoid Target Organ Damage

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79
Q

What are the clinical manifestations of a Hypertensive Crisis?

A

Hypertensive Encephalopathy + Severe Headache + N/V + Seizures + Confusion + Coma + Cerebral Edema + Papilledema

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80
Q

What are the clinical manifestations of a Hypertensive Crisis if it persists?

A

Renal Failure + Retinal Damage + Heart Failure + Pulmonary Edema + Aortic Dissection + Unstable Angina (Leading to MI)

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81
Q

What can be expected with a pt who is in hypertensive crisis, but has a long history of hypertension?

A

They can tolerate the high BP better than those who don’t have a history of it

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82
Q

What is Hypertensive Encephalopathy?

A

General Brain Dysfunction (Due to significantly high BP)

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83
Q

What is Papilledema?

A

Edema of the Optic Discs in your Eyes

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84
Q

What is Aortic Dissection?

A

This is a serious condition that occurs whenever the inner layer of the Aorta tears

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85
Q

How do you classify a Hypertensive Crisis?

A

By how fast it developed + How slowly we need to lower the BP + Amount of Target Organ Damage

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86
Q

The association of the elevated BP to organ damage determines the seriousness of hypertensive crisis, not the actual BP itself.
True or False?

A

True

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87
Q

What are the two classifications of Hypertensive Crisis called?

A

Hypertensive Urgency
Hypertensive Emergency

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88
Q

How long does Hypertensive Urgency take to develop?

A

Hours to Days

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89
Q

What’s the difference between Hypertensive Urgency and Hypertensive Emergency?

A

Hypertensive Urgency has no current signs of Target Organ Damage.
Hypertensive Emergency has evidence of Target Organ Damage involved.

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90
Q

How high is Hypertensive Urgency usually?

A

180/120 mmHg

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91
Q

How is Hypertensive Urgency treated?

A

Outpatient Treatment:
PO Meds + Frequent Follow Up + Oral Hypertensive Drugs

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92
Q

How is Hypertensive Emergency treated?

A

Hospitalization / ICU:

IV Antihypertensives (To SLOWLY lower BP) + IV Vasodilators

Monitoring for Target Organ Damage + Monitor MAP for better evaluation

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93
Q

How do you figure out a pt’s MAP?

A

(SBP + 2DBP) / 3

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94
Q

If a BP is lowered too quickly in a body that’s already adjusted to a high BP, what can it cause?

A

Stroke + MI + Visual Changes

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95
Q

A pt with a Hypertensive Crisis will have an Arterial Line inserted in order to continually monitor-

A

BP + Continuous EKG + Hourly Urine Output Monitoring + Frequent Neuro Checks + Be on complete bed rest

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96
Q

Why might a Stroke pt have an Elevated BP?

A

It could be the body’s way of compensating (To try to get blood to the Ischemic Brain Tissue)

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97
Q

Progressive narrowing of Arterial Lumen of Upper and Lower Extremities =

A

Peripheral Arterial Disease (PAD)

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98
Q

Most common cause of PAD =

A

Atherosclerosis

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99
Q

PAD is a marker that can be used to indicate-

A

Coronary Artery Disease

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100
Q

What are the 4 major risk factors of PAD?

A

Tobacco Use + Uncontrolled HTN + Hyperlipidemia + Diabetes

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101
Q

What are the non-major risk factors of PAD?

A

Elevated CRP + Obesity + Elevated Triglycerides + Sedentary Lifestyle + Family History + Family History + Stress + Getting Older + Low Socioeconomic Status + Women + African Americans

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102
Q

When do start experiencing the clinical manifestations of PAD?

A

At 60-75% Occlusion

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103
Q

What are the commonly involved arteries with PAD?

A

Coronary + Carotids + Aortic Bifurcation + Iliac + Femoral + Politeal

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104
Q

With PAD, there will be stretches of good arteries and then stretches of bad arteries.
True or false?

A

True

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105
Q

How are Peripheral Arterial Disease and Peripheral Vascular Disease different?

A

They’re the same thing

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106
Q

PAD doesn’t increase with age.
True or false?

A

False

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107
Q

When does PAD start to appear normally?

A

After 60 years old (But can be present earlier in Diabetics)

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108
Q

If you have PAD, you are at a great risk for-

A

Major Cardiac Event (MI, Stroke)

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109
Q

What are the severity of the symptoms of PAD dependent on?

A

Site + Collateral Circulation

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110
Q

What are the symptoms of PAD (Lower Extremities)?

A

Intermittent Claudication (Hallmark) + Paresthesia + Thin, Shiny, Hairless Skin + Thickened Toenails + Diminished / Absent Peripheral Pulses (Pedal, Popliteal, Femoral) + Elevation Pallor & Dependent Rubor + Rest Pain (Rest Ischemia) + Arterial Ulcers + Critical Limb Ischemia

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111
Q

What are Arterial Ulcers?

A

Bony prominences of Toes, Feet, and Lower Leg

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112
Q

What is Dependent Rubor?

A

When the skin becomes red or husky when below the level of the heart

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113
Q

What is Elevation Pallor?

A

The skin becomes pale when elevated (Sign of poor blood flow)

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114
Q

What is Parasthesia?

A

Secondary to Nerve Tissue Ischemia, Numbness or Tingling in the Toes or Feet

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115
Q

What is Intermittent Claudication?

A

Cramping or Aching in the Calves, Thighs, and Buttocks that occurs with a predictable level of activity

(Pain during exercise that’s resolved with rest)

116
Q

What should always be advised against for patients (with issues like Parasthesia) when a lack of feeling is an issue?

A

Heating Pads always should be avoided whenever there’s a lack of feeling

117
Q

Do veins have pulses and control skin temperature?

A

No, only Arteries control skin temp and have a pulse

118
Q

Which artery is the most commonly affected in pt’s with PAD who aren’t Diabetic?

A

Femoral Popliteal

119
Q

By the time Intermittent Claudication occurs, the vessel is often already how occluded?

A

70% Occluded

120
Q

Diminished or Absent Petal, Popliteal, or Femoral Pulses are all indicators of-

A

PAD

121
Q

What is Rest Ischemia most often described as?

A

A burning sensation in the lower legs

122
Q

When does Rest Ischemia occur the most?

A

At Night

123
Q

What can PAD progress to? What must you do if this begins to happen?

A

Ulcers or Gangrene.

Must Revascularize the area, usually done with Surgery.

124
Q

What is Critical Limb Ischemia?

A

Chronic Ischemia that lasts longer than 2 weeks, Arterial Leg Ulcers, or Gangrene

125
Q

What pt’s are at an increased risk for Critical Limb Ischemia?

A

Pt’s with Diabetes mellitus, Heart Failure, or Stroke

126
Q

How can PAD be diagnosed?

A

Doppler Ultrasound
Ankle Bracelet Index

127
Q

Due to decreased arterial blood flow, even tiny minor trauma to the feet like shoes that don’t fit or stubbing toes can lead to-

A

Amputation (Because of infection)

128
Q

How do you determine someone’s ABI?

A

Using a Doppler, take Ankle and Brachial BP. Divide the Ankle SBP by the Brachial SBP

129
Q

What’s the normal ABI range?

A

1.0 - 1.3

130
Q

What ABI range is a sign of Mild PVD?

A

0.71 - 0.9

131
Q

What ABI range is a sign of Moderate PVD?

A

0.41 - 0.7

132
Q

What ABI range is a sign of Severe PVD?

A

Less than 0.4

133
Q

Meds for PAD =

A

Simvastatin (For Cholesterol)
Anti-platelet Agents (ASA, Ticlid, Plavix, Clopidogrel)
Thiazides & ACE Inhibitors (For BP Control)
Pletal, Cilostazol & Pentoxifylline (For the Intermittent Claudication)

134
Q

How much exercise therapy should someone with PAD have?

A

30-45 mins / day for 3 days a week, slowly build 30-60 days.
(Walk, then rest, then walk, then rest again)

135
Q

What should nutrition look like for a person with PAD?

A

Fruits + Vegetables, Whole Grain + Low Cholesterol, Sodium, Saturated Fat

136
Q

Goal BMI for a pt with PAD?

A

Under 25

137
Q

Goal waist circumference for people with PAD =

A

Men = 40 or under

Women = 35 or under

138
Q

Goal Cholesterol intake for a PAD pt?

A

Less than 200 mg per day

139
Q

Goal intake of Sodium for a PAD pt =

A

2 g

140
Q

What is the goal Glycosylated Hemoglobin (A1C) if not diabetic?

A

Under 7

141
Q

What is the goal Glycosylated Hemoglobin (A1C) if not diabetic?

A

Under 6

142
Q

PAD can leave you at a high risk of-

A

MI, Ischemic Stroke, Cardiovascular Related Death

143
Q

A pt with PAD should avoid doing what things with their legs?

A

Avoid crossing them, putting pillows underneath their knees, putting heating pads on them, exposing them to cold

144
Q

For a pt with PAD, how often should Peripheral Pulses, Pain, Color, Temp, and Cap Refill be assessed?

A

Q4h

145
Q

What things should be used to keep the legs of a pt with PAD warm?

A

Foot Cradle + Lightweight Blankets + Socks + Slippers

146
Q

What device should be used for pulses that are not palpable on a pt with PAD?

A

A Doppler Device

147
Q

What are some Cath Lab procedures that can be used to treat PAD?

A

Percutaneous Transluminal Balloon Angioplasty (PTA) + Stent Placement + Atherectomy + Cryoplasty

148
Q

This is the removal of plaque from an artery =

A

Atherectomy

149
Q

This is when you use gases to cool an area =

A

Cryoplasty

150
Q

What meds are needed post-procedure for a Cath Lab?

A

Antiplatelets

151
Q

What surgeries can treat PAD?

A

Endarterectomy + Peripheral Artery Bypass + Femoral Popliteal (Femoropopliteal) Bypass Surgery + Amputation

152
Q

How does a Femoropopliteal Bipass Surgery treat PAD?

A

Treats severe blockage caused by plaque in the Femoral Artery

153
Q

Is a PTA an invasive or minimally invasive procedure?

A

Minimally Invasive

154
Q

What arteries does a PTA work best on?

A

Iliac and Femoral Arteries

155
Q

How does a bypass graft work on arteries?

A

You take a piece of the pt’s own vein or use a synthetic vein, and use that to carry blood around a lesion

156
Q

How does an Endarterectomy help treat PAD?

A

You open up the artery and remove the obstructing plaque

157
Q

How does Cryoplasty treat PAD?

A

Uses a balloon to insert cooling gases a Stenosed area to limit Restenosis by reducing muscle cell activity

158
Q

If an artery is Stenosed, it is-

A

Filled with Plaque

159
Q

Most common Peripheral Artery Bypass Surgery?

A

Femoral Popliteal Bypass

160
Q

Things to report for a pt who just had Peripheral Artery Bypass Surgery? Why?

A

Pain Increase + Loss of previously palpable pulses + Extremity pallor or cyanosis + Numbness or tingling + Cold extremities

Graft or Stent may have Occluded

161
Q

What should a pt who just had Peripheral Artery Bypass Surgery avoid?

A

Prolonged Sitting + Flexing the Knees

162
Q

When should a pt who just had Peripheral Artery Bypass Surgery leave their bed to walk?

A

Leave bed by day 1 post-operatively

163
Q

When teaching a patient with PAD, which statement by the patient indicates a need for further teaching?

A.) “I think I can quit smoking with the use of short-term nicotine replacement and support groups.”
B.) “I should not walk if they cause pain in my legs.”
C.) “I should not use heating pads to warm my feet.”
D.) “I will examine my feet every day for any sores or red areas.”

A

B

164
Q

Where do Arterial Ulcers form?

A

Bony prominences of feet and lower leg

165
Q

Symptoms of Arterial Ulcer?

A

Absent Pulse with no Edema or Dermatitis / Pruritus + Elevation Pallor + Dependent Rubor + Cool temp gradient down the leg

166
Q

What should the edges of an Arterial Ulcer look like?

A

Rounded / Smooth

167
Q

What Thromboangitis Obliterans also called?

A

Buerger’s Disease

168
Q

This is a Non-Atherosclerotic Occlusive Vascular Disease where small and midsize Peripheral Arteries become Inflamed and Spastic, causing the formation of blood clots to occur =

A

Buerger’s Disease

169
Q

This is the single most significant cause of Buerger’s Disease =

A

Smoking

170
Q

Clinical manifestations of Buerger’s Disease?

A

Pain in Affected Extremity + Claudication / Cramping Pain in Calves or Feet, Forearms, & Hands + Paresthesia

171
Q

What will a pt’s involved digits/extremities will be like if they have Buerger’s Disease?

A

Pale + Cyanotic or Ruddy / Red + Cold or Cool to touch + Distal Pulses difficult to palpate or are absent

172
Q

Does Buerger’s Disease affect upper extremities or lower extremities?

A

Both

173
Q

What’s the main risk group for Burger’s Disease?

A

Men younger than 45 with a long history of tobacco / marijuana use + Chronic Peridontal Infection with no other risk factors for heart disease

174
Q

What is Burger’s Disease marked by?

A

Dramatic Exacerbations + Marked Remissions

175
Q

How long might Buerger’s Disease remain dormant for?

A

Weeks, Months, or Years

176
Q

Prolonged periods of Tissue Hypoxia increase the risk of -

A

Tissue Ulceration + Gangrene

177
Q

Buerger’s Disease can make it impossible to assess a pt’s distal pulses, even when using a Doppler.
True or false?

A

True

178
Q

What can be used to diagnose Buerger’s Disease?

A

History & Physical Exam

179
Q

What needs to happen for pt’s with Buerger’s Disease?

A

Complete cessation of any tobacco or marijuana use + Keep extremities warm + Manage stress + Keep affected extremities in dependent position + Prevent injury to affected tissues + Regular exercise + ATB to treat ulcers + Pain management

180
Q

What pain med can be used for pain caused by Buerger’s Disease?

A

IV Iloprost

181
Q

Single most important component to managing Buerger’s Disease =

A

Complete Smoking Cessation

182
Q

Can a pt with Buerger’s Disease use a Nicotine Patch or other Nicotine Replacement Products as they try to stop smoking?

A

No

183
Q

How much exercise does someone with Buerger’s Disease need?

A

20 mins or more of walking several times a day

184
Q

What is Raynard’s Phenomenon Disease?

A

Episodes of Vasospasms of small arteries of fingers, toes, ears, and nose

185
Q

What will your color be like for Raynaud’s Phenomenon?

A

Color changes from White to Blue to Red

186
Q

What are Raynaud’s Phenomenon precipitated by?

A

Emotional Upsets + Exposure to Cold + Tobaccos use + Caffeine use

187
Q

How can Raynaud’s Phenomenon be treated?

A

Put hands in warm water (NOT HOT) + stress management + avoid caffeine & vasoconstrictive meds, statins, nifedipine

188
Q

What’s Raynaud’s Phenomenon caused by?

A

Abnormalities in the Vascular, Intravascular, and Neuronal Mechanisms that cause an imbalance between Vasodilation & Vasoconstriction

189
Q

In what people does Raynaud’s Phenomenon usually occur in?

A

Women aged 15-40

190
Q

What are the types of Raynaud’s Phenomenon?

A

Primary Raynaud’s Phenomenon
Secondary Raynaud’s Phenomenon

191
Q

What’s the difference between Primary and Secondary Raynaud’s Phenomenon?

A

Primary has no known cause, Secondary does

192
Q

Secondary Raynaud’s Disease often occurs in association with-

A

Autoimmune Diseases (Lupus, Rheumatoid Arthritis)

193
Q

People with Raynaud’s Phenomenon will have an exaggerated response to-

A

Sympathetic Nervous System Stimulation

194
Q

Is there any kind of specific diagnostic test for Raynaud’s Phenomenon?

A

No (Diagnosis is based on persistent signs/symptoms for at least 2 years)

195
Q

Can a person with Raynaud’s Phenomenon use gloves?

A

No

196
Q

If a pt is not responding to conservative treatment of Raynaud’s Phenomenon, what meds can be used to help?

A

Calcium Channel Blockers + Nifedipine + Diltiazem

197
Q

If a pt is not responding to conservative treatment of Raynaud’s Phenomenon, what meds should be avoided?

A

Pseudoephedrine & Other Vasoconstrictors + Amphetamines + Cocaine + Ergotamine

198
Q

What is Phlebitis?

A

Inflammation of walls of small veins of hands or arms that have IV catheter

199
Q

Clinical manifestation of Phlebitis =

A

Redness, pain or tenderness, warmth, edema and palpable cord

200
Q

Risk factors of Phlebitis =

A

Mechanical irritation from the catheter, infusion of irritating meds and catheter location

201
Q

Phlebitis treatment =

A

Remove IV + Apply warm, moist heat + Elevate extremity if edema + Oral or topical NSAIDS

202
Q

Does Phlebitis usually resolve quickly after the IV has been removed?

A

Yes

203
Q

If a pt has Edema caused by Phlebitis, what should be done?

A

Elevate the extremity in order to promote the reabsorption of fluid into the vascular system

204
Q

What is Veinous Thrombosis?

A

Thrombus (clot) due to inflammation of vein

205
Q

What are the types of Venous Thrombosis?

A

Superficial vein thrombosis (SVT)
Venous thromboembolism (VTE)
deep vein thrombosis (DVT)

206
Q

What is Venous Thrombosis a risk for?

A

Detachment-Embolus + Pulmonary Embolism

207
Q

What is a Superficial Thrombophlebitis?

A

Formation of a clot in a Superficial Vein

208
Q

What is a Venous Thromboembolism or Deep Vein Thrombosis?

A

Blood clot in deep vein (Most often Iliac or Femoral Veins)

209
Q

What factors make up the Virchow’s Triad?

A

Venous Stasis + Endothelial Damage to Vein + Hypercoagulability of Blood

210
Q

What is the Virchow’s Triad?

A

The 3 broad categories that are thought to contribute to thrombosis

211
Q

Dysfunctional Valves and/or Inadequate Muscle Action =

A

Venous Stasis

212
Q

What’s responsible for Venous Blood Movement?

A

Competent Valves + Action of Surrounding Muscles

213
Q

Risks for Venous Stasis?

A

Obesity + Pregnant and postpartum women + Immobile for long periods (surgery, illness) + Long trips + Heart failure or atrial fib

214
Q

When does Endothelial Damage occur?

A

When receiving IV Agents that may be Irritating

215
Q

What IV Agents can be Irritating?

A

Antibiotics, K+, Chemo, Hypertonic Fluids, Contrast Media

216
Q

Endothelial Damage can occur if an IV Catheter is left inserted for -

A

Over 72 Hours

217
Q

What disease process can cause Endothelial Damage?

A

Diabetes mellitus

218
Q

What things can predispose you to Endothelial Inflammation and Damage?

A

Direct Damage like damage to the inner lining of the vein (Trauma + External Pressure + Venipuncture)

Indirect Damage (Diabetes mellitus + Chemo + Venous Stasis + Blood Clot)

219
Q

Hypertonic Fluids, such as Total Parenteral Nutrition, can cause what issue to occur?

A

Endothelial Damage

220
Q

What disorders can cause Hypercoagulability to occur?

A

Hematological Disorders (Cancer, Anemia, Malignancies)

221
Q

Risk factors for Hypercoagulability?

A

Dehydration + Malnutrition + Hematological Disorders + Smoking + Oral contraceptives + Menopausal women using HRT + Sepsis

222
Q

What things double the risk Hypercoagulability?

A

Smoking + Oral Contraceptives

223
Q

Manifestations of SVT?

A

Tenderness + Redness, warmth, pain, and induration + Palpable cordlike vein + May or may not have edema + Possible Itchiness

224
Q

How is SVT diagnosed?

A

Physical exam + Venous duplex ultrasound

225
Q

How is SVT treated?

A

Low molecular weight Heparin or Fondaparinux + Oral or topical NSAIDS + Elastic compression stockings (TED hose) + Walking

226
Q

How can you tell which diagnosis technique to use on SVT?

A

Physical Exam if checking Upper Extremities

Venous Doppler Ultrasound if Lower Extremities

227
Q

For SVT, what meds should be used for Inflammation?

A

Ibuprofen or Diclofenac

228
Q

Risk factors of SVT =

A

Getting Older + Obesity + Pregnancy + Estrogen Therapy + History of SVT or DVT

229
Q

Low Molecular Weight Heparin is often used for SVT that’s in which extremities?

A

Lower Extremities

230
Q

When is Symptomatic Treatment used for SVT?

A

Used for SVT of the Short Vein Segment (<5 cm)

231
Q

Symptoms of Deep Vein Thrombosis (DVT) or Venous Thromboembolism on Extremities?

A

May be asymptomatic

Tenderness or pain on palpation + Warm skin + Sense of fullness in thigh or calf + Unilateral leg edema + Dilated superficial veins + Paresthesias + Erythema + Oral temperature greater than 100.4 degrees F

232
Q

What complications can occur because of Deep Vein Thrombosis (DVT) or Venous Thromboembolism?

A

Pulmonary Embolism + Chronic Venous Insufficiency

233
Q

DVT can occur in what places?

A

Deep veins of Pelvis & Lower Extremities most common

Can also occur in the Axilla, Subclavian, and the Inferior/Superior Vena Cava

234
Q

If the Inferior Vena Cava is involved in a case of DVT, what are some indicators?

A

Symptoms in the lower extremities with Edema and Cyanosis

235
Q

If the Superior Vena Cava is involved in a case of DVT, what are some indicators?

A

Symptoms in the upper extremities, neck, back, and face

236
Q

This is a really unreliable sign for DVT that has a lot of false positives =

A

Homan’s Sign

237
Q

Most common symptom of Vein Thrombosis (DVT) or Venous Thromboembolism =

A

Calf Pain

238
Q

What occurs during a Pulmonary Embolism? Is it Life-Threatening?

A

Yes. An Embolus advances through the venous system, into the heart, and into the Pulmonary Circulation

239
Q

What is Chronic Venous Insufficiency?

A

Damage to the Valves in Veins. This allows for retrograde blood flow + edema + increased pigment + varicosities + ulcerations

240
Q

How long would it take for Chronic Venous Insufficiency to occur after a DVT?

A

Several Years

241
Q

How is a Venous Thromboembolism diagnosed?

A

Venous Doppler (ultrasound) + Duplex Doppler Scan + Venogram + D-Dimer

242
Q

How does a Duplex Doppler Scan diagnose a Venous Thromboembolism?

A

It combines ultrasound and color doppler graphical images

243
Q

Most widely used test to diagnose DVT =

A

Duplex Doppler Scan

244
Q

What’s a D-Dimer?

A

A type of blood test that detects Fragments of Fibrin Degradation and Clot Breakdown.
Elevation is suggestive of DVT.

245
Q

When does a D-Dimer produce Elevated Results?

A

When there’s a clot in the body as a result of the body’s attempt to break it down

246
Q

What is the reason to use TEDS or SCUDS?

A

Prevention and Prophylaxis

247
Q

What are some nursing interventions for pt’s wearing SCUDS or TEDS?

A

Early and aggressive ambulation + If bedrest, change position q 2 hrs + Teach pt to flex and extend feet, knees, and hips q2-4 hrs + Up in chair for meals + Ambulate 4-6 times per day as tolerated + Elastic compression stockings (TED hose) + Sequential Compression Devices (SCDs) + Preventative anticoagulation

248
Q

For pt’s wearing TEDS or SCUDS, what things should be avoided?

A

Sitting with legs crossed for long periods + Smoking + Abnormal weight + Sitting or Standing for long periods + Estrogen Containing Contraceptives + Dehydration

249
Q

For pt’s wearing TEDS or SCUDS, what preventative med may or may not be ordered, according to the pt’s risk for VTE?

A

Anticoagulants

250
Q

In regards to VTE Assessment, how often should peripheral pulses, skin integrity, capillary refill times and color of extremities be assessed?

A

Every 8 hrs

251
Q

When are SCD’s not recommended?

A

If already receiving an active VTE

252
Q

How long should a TED hose or SCD stocking be removed during daily bath?

A

30-60 min

253
Q

How long can a SCD or TED Hose be?

A

Knee High or Thigh High

254
Q

A TED Hose or SCD can impede venous return if-

A

Put on too tightly

255
Q

What classification is Heparin?

A

An Anti-Coagulant

256
Q

What’s the antidote to Heparin?

A

Protamine Sulfate

257
Q

What is the normal aPTT lab value range?

A

30-40 Seconds

258
Q

What lab value is used to assess the blood’s coagulation properties?

A

aPTT

259
Q

When are Anticoagulants required?

A

When the pt’s aPTT value is 1.5 - 2.5 times the normal value

260
Q

What is Heparin Induced Thrombocytopenia?

A

Heparin Induced Low Platelets

261
Q

What are Direct Thrombin Inhibitors (DTI’s)?

A

Anticoagulants that do not cause Heparin Induced Thrombocytopenia

262
Q

What are the 3 DTI’s that have been approved by the FDA Administration?

A

Lepirudin + Argatroban + Bivalirudin

263
Q

What is Enoxaparin?

A

Low Molecular Weight Heparin

264
Q

How should Low Molecular Weight Heparin be Administered?

A

SUBQ, Anterolateral Abdomen

265
Q

What shouldn’t be done when administering Low Molecular Weight Heparin?

A

Routine coagulation tests are unrequired

Aspirate, injecting IM, massage site, don’t expel air bubble

266
Q

What class is Warfarin?

A

Anticoagulant

267
Q

Warfarin Antidote?

A

Vitamin K

268
Q

Should take Warfarin if-

A

Pregnant

269
Q

Normal lab value range for the blood test called INR?

A

0.75-1.25

270
Q

For a heart valve replacement, the INR should be kept at a range of-

A

2.5-3.5

271
Q

For most cardiac related surgeries, the INR should be kept at a range of-

A

2-3

272
Q

When is the INR not supposed to be used?

A

During the initiation of Coumadin therapy

273
Q

What’s recommended if Anticoagulant therapy is contraindicated due to risk of bleeding?

A

Vena Cava Interruption Devices

274
Q

What do Vena Cava Interruption Devices do?

A

Filter clots but don’t interfere with blood flow

275
Q

What complications may occur after the insertion of a Vena Cava Interruption Device?

A

Air embolism, improper placement, migration of filter and perforation of vena cava with retroperitoneal bleeding

276
Q

Describe Chronic Venous Insufficiency =

A

Incompetent venous valves
Retrograde venous blood flow
Increased hydrostatic pressure
Fluid/RBCs leak into tissue and are broken down
Skin & tissue of ankle becomes thick, hard, and fibrous

277
Q

Chronic Venous Insufficiency can lead to-

A

Venous Leg Ulcers

278
Q

Manifestations of Chronic Venous Insufficiency?

A

Itching
Leathery skin on lower leg
Brown or brawny color
Edema-especially if leg dependent
C/O heavy feeling in leg/dull ache
Eczema/stasis dermatitis
Skin warm in area
Venous ulcers (old term- ‘stasis ulcer’)

279
Q

Where can Venous Ulcers typically be found?

A

Around or above medial malleolus

280
Q

Cellulitis and Secondary Lymphedema can be caused by-

A

Venous Ulcers

281
Q

What can result in Osteomyelitis or Malignant Changes?

A

Venous Ulcers

282
Q

What does a Venous Ulcer look like?

A

Irregularly Shaped Edges + Ruddy Color + Deepens if left untreated

283
Q

When a Venous Ulcer is left untreated, the pain may be more painful whenever the leg is in what position?

A

Dependent Position

284
Q

Compression is an essential treatment for-

A

Venous Ulcers

285
Q

What are all of the treatments for Veinous Ulcers?

A

Compression + Moist dressings (Hydrogels) + Paste bandage called Unna boot + Nutrition (Protein, Vitamin A & C, Zinc) + Antibiotics only if infected + Herbal therapy (horse chestnut seed extract) + Teach self-care measures

286
Q

Side effects of Horse Chestnut Seed Extract?

A

Dizziness + GI Complaints + Headache + Pruritis

Nursing Across the Lifespan 1 (Exam 1 Prep) (9 decks)

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