Vascular Problems Flashcards
What is the difference between arteriosclerosis and atherosclerosis?
– arteriosclerosis: thickening/hardening of arterial wall
- associated with aging
– atherosclerosis: type of arteriosclerosis; formation of plaque within arterial wall
– both of these usually affect the larger arteries
What are some assessments for arteriosclerosis?
- physical:
- BP
- pulses
- cap refill
- temperature of lower extremities
- labs:
- lipid panel
- triglycerides
- homocysteine
- increased levels make cell walls more vulnerable to plaque build-up
What are some interventions for arteriosclerosis?
- diet:
- maintain healthy weight
- consume variety of nutritious foods
- cholesterol management
- fat intake < 30% of total calories
- < 10% from saturated fats
- fat intake < 30% of total calories
- drugs:
- HMG-CoA inhibitors (-statins)
- reduce total cholesterol by reducing processing of cholesterol in liver and increasing clearance of LDL in blood
- ezetimibe (Zetia)
- absorbs cholesterol through small intestine
- HMG-CoA inhibitors (-statins)
How is hypertension defined?
– pts without DM:
- systolic BP greater than or equal to 140
- diastolic BP greater than or equal to 90
– pts with DM:
- BP > 130/90
What are the 5 classifications of blood pressure?
- normal
- systolic < 120
- diastolic < 80
- prehypertension
- systolic = 120 - 139
- diastolic = 80 - 89
- stage 1
- systolic = 140 - 159
- diastolic = 90 - 99
- stage 2
- systolic = 160 - 179
- diastolic = 100 - 109
- stage 3
- systolic greater than or equal to 180
- diastolic greater than or equal to 110
What are the 3 types of hypertension?
– primary (essential) HTN: HTN that does not result from another medical condition
- causes damage to vital organs
- causes thickening of arterioles
- 95% of HTN pts
– secondary HTN: HTN that stems from another disease process or another disorder
- more difficult to treat
- common causes:
- renal disease
- primary aldosteronism
- pheochromocytoma – benign, non-cancerous tumor of adrenal glands
- Cushing’s syndrome
- medications
– malignant HTN: severe, rapidly progressing HTN
- severe problem
- BP > 200/150
What are the risks for primary and secondary HTN?
– primary risks:
- family hx
- African American ethnicity
- age
- excessive sodium intake
- excessive caffeine intake
- obesity
- smoking
- stress
– secondary risks:
- kidney disease
- Cushing’s disease
- brain tumors
- primary aldosteronism
- drugs:
- estrogen
- glucocorticoids
What are some assessments for HTN?
- physical:
- often asymptomatic other than h/a and dizziness
- BP readings for both arms
- fundoscopic examination of eyes
- may have hemorrhages in retina
- hard exudates
- cotton wool spots
- psychological assessment – stress can cause elevated BP
- labs:
- can determine secondary HTN
What are some interventions for HTN?
- reduce weight
- restrict sodium
- consume alcohol sparingly
- exercise
- quit smoking
- reduce stress
- drugs:
- long-acting meds are preferred
- better compliance
- cheaper
- stepped therapy
- diuretics – first line of therapy
- calcium channel blockers
- cause vasodilation
- do not use in pts with HF – already compromised heart contractility
- ACE inhibitors
- cause vasodilation while preserving renal function
- preferred drug for pts with HF or DM
- angiotensin II receptor antagonists
- aldosterone receptor antagonists
- beta blockers (-olol)
- decreases HR and contractility
- causes vasodilation
- preferred drug for pts with ischemic heart disease
- can cause bronchospasm
- careful with pts with asthma
- long-acting meds are preferred
What is peripheral vascular disease (PVD)? What is the most common location for PVD? What are some causes of PVD?
– peripheral vascular disease (PVD): disorders that change the natural flow of blood in peripheral circulation (either arterial or venous)
- usually implies arterial disease – more severe than venous
– most common location = legs
– causes = chronic, systemic atherosclerosis
What are some assessments that might indicate PVD?
-
intermittent claudication: leg pain that occurs following walking for a short distance
- cramping
- burning
- muscle pain
- pain at rest
- pain worsens over time
- hair loss on lower extremities
- dry, pale, mottled skin
- thickened toenails
- rubor: redness when extremities are lowered
What are some diagnostic tests for PVD?
- arteriography: IV contrast dye to visualize occlusions
- doppler probe: systolic BP readings of thigh, calf, and ankle
What are some interventions for PVD?
- exercise
- start gradually
- walk to point of claudication, then stop and rest
- poistioning
- don’t raise above level of heart
- promote vasodilation
- warmth to extremity
- prevent exposure to cold
- avoid things that cause vasoconstriction
- stress
- caffeine
- nicotine
- drugs
- antiplatelets – increase blood flow to extremities
- vasodilators
- like HTN meds
- percutaneous transluminal angioplasty
- atherectomy: scraping of plaque from artery with a rotoblader
- surgery
- arterial revascularization (bypass)
What are the 6 P’s of arterial insufficiency?
- pain
- pallor
- pulselessness
- paresthesia
- paralysis
- poikilothermia (coolness)
What is an acute peripheral arterial occlusion? What are some interventions?
– acute peripheral arterial occlusion: an occlusion that affects blood flow
- most commonly caused by embolus
- more common in lower extremities
- may occur in upper extremities, especially in pts with IV drug addictions
– interventions:
- drugs
- thrombolytics
- surgery
