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MedSurge 3 > Vascular problems > Flashcards

Vascular problems Flashcards

1
Q

What is the recommended BP for all people according to the American heart association?

A

below 130/80

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2
Q

Ideal BP for people over 60

A

below 150/90

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3
Q

Ideal BP for people younger than 60

A

140/90

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4
Q

What 4 control systems play a major role in maintaining blood pressure?

A

arterial baroreceptor system
regulation of body fluid volume
RAAS
vascular autoregulation

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5
Q

Arterial baroreceptors

A

-found in carotid sinus, aorta, wall of left ventricle
-monitor level of arterial pressure and counteract rise in arterial pressure

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6
Q

How does changes in fluid volume affect arterial pressure?

A

if there is an excess of sodium/water, BP rises and changes venous return, increased CO

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7
Q

Explain RAAS

A

-kidney produces renin
-acts on angiotensinogen to split angiotensin I and II
-angiotensin I, converted by an enzyme in lung, to angiotensin II
-Angiotensin II vasoconstricts
-Aldosterone helps reabsorb sodium

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8
Q

4 levels of blood pressure

A

1.) normal
2.) elevated (prehypertensive)
3.) stage 1 hypertension
4.) stage 2 hypertension

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9
Q

Essential/ primary hypertension

A

most common
results in damage to vital organs by causing thickening of arterioles
slow onset

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10
Q

Secondary HTN

A

caused by specific disease or drugs

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11
Q

Risk factors to primary HTN

A

obesity
smoking
stress
family hx

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12
Q

Hypertensive crisis

A

Severely elevated BP that rapidly progresses
BP higher than 180/110

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13
Q

What meds to avoid for hypertensive crisis?

A

inotropic, dopamine, any vasoconstrictive properties

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14
Q

What are some causes of secondary HTN?

A

kidney disease
adrenal medulla or cortex dysfunction

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15
Q

What is Adrenal-mediated hypertension?

A

primary excess of aldosterone, cortisol, or catecholamines
causes HTN and hypokalemia

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16
Q

what are some drugs that can cause HTN?

A

glucocorticoids
mineralocorticoids
estrogen (oral contraceptives)
sympathomimetics
cyclosporine
erythropoietin

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17
Q

what are some ways to decreased HTN?

A

weight reduction
exercise
DASH diet
consumption of sodium less than 1500mg (1-2g)

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18
Q

What are some healthy foods to eat to combat HTN?

A

veggies
fruits
whole grains
fat free/low fat dairy
fish
poultry
beans
nuts
vegetable oils

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19
Q

What are foods to avoid with HTN?

A

fatty meats
full fat dairy
sugar sweetened beverages
sweets
high sodium foods

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20
Q

DASH acronym

A

Dietary Approaches to Stop Hypertension

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21
Q

What classifies as orthostatic hypertension?

A

decrease in BP when changing positions from lying to sitting
a drop in 20 systolic
10 diastolic

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22
Q

drug alert for thiazide diuretics

A

men may experience decreased libido
caution for pts with diabetes as thiazide can interfere with glucose control
gout or hyponatremia can worsen

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23
Q

Patient education for potassium-depleting diuretics and give examples

A

eat foods high in potassium
bananas, potatoes, orange juice

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24
Q

what are ACE Inhibitors?

A

Angiotensin converting enzyme inhibitor
blocks the conversion of angiotensin I to angiotensin II, prevents sodium and water retention

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25
Q

What are some examples of ACE inhibitors?

A

captopril, lisinopril, benazepril, enalapril

Remember “pril”

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26
Q

risk factors for ACE inhibitors

A

dry, hacking cough
angioedema
hyperkalemia

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27
Q

Nursing interventions for ACE inhibitors

A

assess for hyperkalemia
monitor BP/ orthostatic

Why do we need to assess for hyerkalemia?

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28
Q

What are ARBs?

A

Angiotensin receptor II blocker
blocks angiotensin II causing vasodilation and increased Na and water secretion

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29
Q

What are some examples of ARBs?

A

losartan, valsartan, azilsartan

remember “sartan”

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30
Q

How long do ARB’s take to be effective?

A

3-6 weeks

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31
Q

Nursing interventions for ARBs?

A

teach to avoid high potassium foods
monitor BP and orthostatic

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32
Q

What are beta blockers and what do they do?

A

blocks beta receptors in heart resulting in decreased HR, contractility, and BP

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33
Q

What are the side effects to BBs?

A

lethargy, sexual dysfunction, depression, GI disturbance, CHF, bradycardia
may cause bronchospasms for patient with COPD and asthma

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34
Q

What do you need to remember about BB in regards to diabetes?

A

beta blockers also block the manifestations of hypoglycemia because the sympathetic nervous system is blocked

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35
Q

What is important to tell patients taking beta blockers and why?

A

do not stop abruptly, taper off over a 2 week period
abruptly stopping can lead to angina or MI

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36
Q

What are some examples of beta blockers?

A

atenolol, metoprolol, propranolol

remember “lol”

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37
Q

What are the parameters for beta blockers?

A

do not give if HR is less than 50-60
hold if systolic is less than 90-100

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38
Q

What are the parameters for ARBs?

A

do not give if systolic is below 100

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39
Q

What are the parameters for ACE inhibitors?

A

do not give if systolic is below 100

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40
Q

Nursing interventions for beta blockers

A

monitor for orthostatic hypotension
assess HR and BP

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41
Q

What are calcium channel blockers?

A

blocks influx of calcium ions resulting in vasodilation decreasing BP
also blocks SA and AV node conductions decreasing HR

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42
Q

Examples of calcium channel blockers

A

amlodipine, verapamil, nifedipine, diltiazem, felodipine

Remember “pine”

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43
Q

What is important to know about calcium channel blockers?

A

some like felodipine and nifedipine react with grapefruit or grapefruit juice and enhances action of drug

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44
Q

What are the side effects of diuretics?

A

hypokalemia, digoxin toxicity, orthostatic hypotension

45
Q

S/s of hypertensive crisis

A

severe headache
extremely high BP
dizziness
SOB
epistaxis
severe anxiety

46
Q

What are some meds a patient can receive during a hypertensive crisis?

A

nicardipine, fenoldopam, labetalol

47
Q

For adults without a compelling condition, systolic BP should be reduced by no more than [blank] within the first hour

A

25%

48
Q

Nursing interventions during a hypertensive crisis

A

place pt in semi fowlers
give oxygen
give IV beta blocker and then switch to oral
MONITOR BP q 5-15 MINS UNTIL DIASTOLIC IS BELOW 90 NOT LESS THAN 75
then monitor q 30 min
observe for seizures, numbness, weakness, tingling

49
Q

Arteriosclerosis

A

thickening or hardening of the arterial wall often associated with aging

50
Q

Atherosclerosis

A

A TYPE of arteriosclerosis
formation of plaque within arterial wall
leads to cardiovascular disease

51
Q

Risk factors for atherosclerosis

A

Low LDL cholesterol
diabetes
obesity
hypertension
smoking
sedentary lifestyle
stress
hyperlipidemia

52
Q

What do you assess for atherosclerosis?

A

BP in both arms
palpate pulses and note differences
capillary refill
listen for bruit

53
Q

What are HMG-CoA reductase inhibitors?

A

-statins
reduces total cholesterol by reducing cholesterol synthesis in the liver
HMG-CoA is the enzyme needed in cholesterol formation

54
Q

Examples of HMG-CoA reductase inhibitors?

A

Atorvastatin
lovastatin
simvastatin

55
Q

Drug alert for -statins

A

contraindicated for people with liver disease or pregnancy
interacts with warfarin, cyclosporine
avoid grapefruit

56
Q

What does ezetimibe do?

A

inhibits absorption of cholesterol thru small intestine

57
Q

examples of combination drugs for atheriosclerosis?

A

Vytorin (ezetimibe and simvastatin)
Caduet (Amlodipine and atorvastatin)

58
Q

Peripheral Vascular Disease

A

disorders that change natural flow of blood thru arteries and veins causing decreased profusion

59
Q

PVD can happen from..?

A

atherosclerosis
spasm
inflammation
trauma
compression
thrombus/embolus

60
Q

Stages of PAD

A

1.) Asymptomatic
2.) Claudication
3.) Rest pain
4.) Necrosis/gangrene

61
Q

Stage 1 of PAD

A

asymptomatic
bruit or aneurysm may be present
pedal pulses are decreased or absent

62
Q

Stage 2 of PAD

A

Claudication
muscle pain, cramping, or burning with exercise and is relieved with rest

63
Q

Stage 3 of PAD

A

Rest pain
commonly awakes pt at night
numbness, burning, toothache-type pain
occurs in distal part of extremity
pain relieved by placing in a dependent position

64
Q

Stage 4 of PAD

A

Necrosis/gangrene
ulcers and blackened tissue on toes, forefoot and heel
odor

65
Q

Inflow disease

A

discomfort in lower back, buttocks, or thighs

66
Q

Outflow disease

A

burning or cramping in calves, ankles, feet, and toes

67
Q

what are some specific findings for PAD

A

loss of hair on lower calf, ankle, foot
dry pale or mottled skin
thick toenails
rubor when extremity is lowered

68
Q

What are the six P’s?

A

Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Poikilothermia (coolness)

69
Q

What is a life threatening medical emergency you want to monitor for with PAD/occlusion?

A

Compartment syndrome

70
Q

What is Ankle Brachial Index?

A

estimates severity of PAD in leg by comparing with measured pressure in arm

71
Q

Normal ABI index

A

0.9-1.0

72
Q

Mild PAD ABI range

A

0.71-0.90

73
Q

Moderate PAD ABI range

A

0.41-0.7

74
Q

Severe PAD ABI range

A

< 0.4

75
Q

Nonsurgical treatment for PAD

A

Exercise
positioning
promoting vasodilation
drug therapy

76
Q

How does exercise help with PAD?

A

improve arterial blood flow thru buildup of collateral circulation

77
Q

what is collateral circulation?

A

provides blood to affected area thru small vessels that develop and compensate for occluded vessels

78
Q

Patient education for PAD

A

avoid crossing legs
avoid restrictive clothing
teach to inspect feet daily

79
Q

Percutaneous vascular intervention

A

Nonsurgical, invasive procedure that requires an arterial punction in groin and arteries are dilated with a balloon catheter to improve blood flow

80
Q

Who qualifies for percutaneous vascular intervention?

A

occlusions or stenosed artery that are accessible to catheter

81
Q

Atherectomy

A

removal of the plaque from inside the artery

82
Q

Acute arterial occlusion

A

sudden and dramatic
embolus travels and lodges in a new area

83
Q

what is compartment syndrome?

A

tissue pressure within a confined body space elevates and restricts blood flow

84
Q

How often do you monitor platelets of a pt on fibrinolytics?

A

the first 3,6, and 12 hours of the start of infusion

85
Q

What is an aneurysm?

A

permanent localized dilation of an artery which enlarges the artery
middle layer of artery is weak and produces a stretching effect

86
Q

Fusiform aneurysm

A

affects the entire circumference of the artery

87
Q

Saccular aneurysm

A

affects only distinct portion of artery

88
Q

True aneurysm

A

arterial wall is weakened by congenital or acquired problems

89
Q

False aneurysm

A

a result of vessel injury or trauma to all three layers of arterial wall

90
Q

Dissecting aneurysm

A

formed when blood accumulates in the wall of an artery

91
Q

what is the most common aneurysms?

A

Abdominal aortic

92
Q

What do you assess for with a suspected or know AAA?

A

abdominal, flank, back pain
pain described as steady with gnawing quality unaffected by movement
pulsation in upper abdomen between xiphoid process and umbilicus
bruit

93
Q

s/s of thoracic aortic aneurysm

A

back pain
SOB
difficulty swallowing
may have mass above suprasternal notch

94
Q

Nursing management for AAA

A

monitor q 1 hr: BP, vasodilators, urinary output, murmur, circulation

95
Q

Aortic dissection

A

sudden tear in the aortic intima and blood enters aortic wall
can cause stroke, MI or death

96
Q

s/s of aortic dissection

A

sharp, ripping or stabbing pain that moves from its origin
diaphoresis
nausea and vomiting
faintness
pallor
rapid and weak pulse
elevated BP

97
Q

nursing interventions for aortic dissection

A

2 large bore IVs
foley
NS

98
Q

problems that can alter blood flow in veins

A

venous thromboembolism
defective valves/varicose veins
skeletal muscles do not contract to help pump blood

99
Q

Phlebothrombosis

A

thrombus without inflammation

100
Q

thrombophlebitis

A

thrombus associated with inflammation
occur in superficial veins

101
Q

Deep Vein Thrombosis (DVT)

A

blood clot that forms in a vein deep in the body
commonly in deep veins of legs

102
Q

Virchow’s triad and name them

A

predisposing factors to DVT
statis of blood, endothelial injury, hypercoagulability

103
Q

Assessment for DVT

A

history
risk factors
calf or groin tenderness
sudden swelling of leg
warmth or edema

104
Q

Interventions to prevent DVT formation

A

patient education
leg exercises
early ambulation
adequate hydration
graduated compression stockings
SCDs
anticoagulants

105
Q

Venous insufficiency

A

prolonged venous hypertension that stretches veins and damages valvess

106
Q

s/s of venous insufficiency

A

leg edema, stasis dermatitis, stasis ulcers

107
Q

Varicose veins

A

distended protruding veins

108
Q

treatment for varicose veins

A

Elastic compression hose
exercise
elevation

MedSurge 3 (28 decks)

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