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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
What are some examples of ACE inhibitors?
captopril, lisinopril, benazepril, enalapril | Remember "pril"
26
risk factors for ACE inhibitors
dry, hacking cough angioedema hyperkalemia
27
Nursing interventions for ACE inhibitors
assess for hyperkalemia monitor BP/ orthostatic | Why do we need to assess for hyerkalemia?
28
What are ARBs?
Angiotensin receptor II blocker blocks angiotensin II causing vasodilation and increased Na and water secretion
29
What are some examples of ARBs?
losartan, valsartan, azilsartan | remember "sartan"
30
How long do ARB's take to be effective?
3-6 weeks
31
Nursing interventions for ARBs?
teach to avoid high potassium foods monitor BP and orthostatic
32
What are beta blockers and what do they do?
blocks beta receptors in heart resulting in decreased HR, contractility, and BP
33
What are the side effects to BBs?
lethargy, sexual dysfunction, depression, GI disturbance, CHF, bradycardia may cause bronchospasms for patient with COPD and asthma
34
What do you need to remember about BB in regards to diabetes?
beta blockers also block the manifestations of hypoglycemia because the sympathetic nervous system is blocked
35
What is important to tell patients taking beta blockers and why?
do not stop abruptly, taper off over a 2 week period abruptly stopping can lead to angina or MI
36
What are some examples of beta blockers?
atenolol, metoprolol, propranolol | remember "lol"
37
What are the parameters for beta blockers?
do not give if HR is less than 50-60 hold if systolic is less than 90-100
38
What are the parameters for ARBs?
do not give if systolic is below 100
39
What are the parameters for ACE inhibitors?
do not give if systolic is below 100
40
Nursing interventions for beta blockers
monitor for orthostatic hypotension assess HR and BP
41
What are calcium channel blockers?
blocks influx of calcium ions resulting in vasodilation decreasing BP also blocks SA and AV node conductions decreasing HR
42
Examples of calcium channel blockers
amlodipine, verapamil, nifedipine, diltiazem, felodipine | Remember "pine"
43
What is important to know about calcium channel blockers?
some like felodipine and nifedipine react with grapefruit or grapefruit juice and enhances action of drug
44
What are the side effects of diuretics?
hypokalemia, digoxin toxicity, orthostatic hypotension
45
S/s of hypertensive crisis
severe headache extremely high BP dizziness SOB epistaxis severe anxiety
46
What are some meds a patient can receive during a hypertensive crisis?
nicardipine, fenoldopam, labetalol
47
For adults without a compelling condition, systolic BP should be reduced by no more than [blank] within the first hour
25%
48
Nursing interventions during a hypertensive crisis
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
Arteriosclerosis
thickening or hardening of the arterial wall often associated with aging
50
Atherosclerosis
A TYPE of arteriosclerosis formation of plaque within arterial wall leads to cardiovascular disease
51
Risk factors for atherosclerosis
Low LDL cholesterol diabetes obesity hypertension smoking sedentary lifestyle stress hyperlipidemia
52
What do you assess for atherosclerosis?
BP in both arms palpate pulses and note differences capillary refill listen for bruit
53
What are HMG-CoA reductase inhibitors?
-statins reduces total cholesterol by reducing cholesterol synthesis in the liver HMG-CoA is the enzyme needed in cholesterol formation
54
Examples of HMG-CoA reductase inhibitors?
Atorvastatin lovastatin simvastatin
55
Drug alert for -statins
contraindicated for people with liver disease or pregnancy interacts with warfarin, cyclosporine avoid grapefruit
56
What does ezetimibe do?
inhibits absorption of cholesterol thru small intestine
57
examples of combination drugs for atheriosclerosis?
Vytorin (ezetimibe and simvastatin) Caduet (Amlodipine and atorvastatin)
58
Peripheral Vascular Disease
disorders that change natural flow of blood thru arteries and veins causing decreased profusion
59
PVD can happen from..?
atherosclerosis spasm inflammation trauma compression thrombus/embolus
60
Stages of PAD
1.) Asymptomatic 2.) Claudication 3.) Rest pain 4.) Necrosis/gangrene
61
Stage 1 of PAD
asymptomatic bruit or aneurysm may be present pedal pulses are decreased or absent
62
Stage 2 of PAD
Claudication muscle pain, cramping, or burning with exercise and is relieved with rest
63
Stage 3 of PAD
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
Stage 4 of PAD
Necrosis/gangrene ulcers and blackened tissue on toes, forefoot and heel odor
65
Inflow disease
discomfort in lower back, buttocks, or thighs
66
Outflow disease
burning or cramping in calves, ankles, feet, and toes
67
what are some specific findings for PAD
loss of hair on lower calf, ankle, foot dry pale or mottled skin thick toenails rubor when extremity is lowered
68
What are the six P's?
Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia (coolness)
69
What is a life threatening medical emergency you want to monitor for with PAD/occlusion?
Compartment syndrome
70
What is Ankle Brachial Index?
estimates severity of PAD in leg by comparing with measured pressure in arm
71
Normal ABI index
0.9-1.0
72
Mild PAD ABI range
0.71-0.90
73
Moderate PAD ABI range
0.41-0.7
74
Severe PAD ABI range
< 0.4
75
Nonsurgical treatment for PAD
Exercise positioning promoting vasodilation drug therapy
76
How does exercise help with PAD?
improve arterial blood flow thru buildup of collateral circulation
77
what is collateral circulation?
provides blood to affected area thru small vessels that develop and compensate for occluded vessels
78
Patient education for PAD
avoid crossing legs avoid restrictive clothing teach to inspect feet daily
79
Percutaneous vascular intervention
Nonsurgical, invasive procedure that requires an arterial punction in groin and arteries are dilated with a balloon catheter to improve blood flow
80
Who qualifies for percutaneous vascular intervention?
occlusions or stenosed artery that are accessible to catheter
81
Atherectomy
removal of the plaque from inside the artery
82
Acute arterial occlusion
sudden and dramatic embolus travels and lodges in a new area
83
what is compartment syndrome?
tissue pressure within a confined body space elevates and restricts blood flow
84
How often do you monitor platelets of a pt on fibrinolytics?
the first 3,6, and 12 hours of the start of infusion
85
What is an aneurysm?
permanent localized dilation of an artery which enlarges the artery middle layer of artery is weak and produces a stretching effect
86
Fusiform aneurysm
affects the entire circumference of the artery
87
Saccular aneurysm
affects only distinct portion of artery
88
True aneurysm
arterial wall is weakened by congenital or acquired problems
89
False aneurysm
a result of vessel injury or trauma to all three layers of arterial wall
90
Dissecting aneurysm
formed when blood accumulates in the wall of an artery
91
what is the most common aneurysms?
Abdominal aortic
92
What do you assess for with a suspected or know AAA?
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
s/s of thoracic aortic aneurysm
back pain SOB difficulty swallowing may have mass above suprasternal notch
94
Nursing management for AAA
monitor q 1 hr: BP, vasodilators, urinary output, murmur, circulation
95
Aortic dissection
sudden tear in the aortic intima and blood enters aortic wall can cause stroke, MI or death
96
s/s of aortic dissection
sharp, ripping or stabbing pain that moves from its origin diaphoresis nausea and vomiting faintness pallor rapid and weak pulse elevated BP
97
nursing interventions for aortic dissection
2 large bore IVs foley NS
98
problems that can alter blood flow in veins
venous thromboembolism defective valves/varicose veins skeletal muscles do not contract to help pump blood
99
Phlebothrombosis
thrombus without inflammation
100
thrombophlebitis
thrombus associated with inflammation occur in superficial veins
101
Deep Vein Thrombosis (DVT)
blood clot that forms in a vein deep in the body commonly in deep veins of legs
102
Virchow's triad and name them
predisposing factors to DVT statis of blood, endothelial injury, hypercoagulability
103
Assessment for DVT
history risk factors calf or groin tenderness sudden swelling of leg warmth or edema
104
Interventions to prevent DVT formation
patient education leg exercises early ambulation adequate hydration graduated compression stockings SCDs anticoagulants
105
Venous insufficiency
prolonged venous hypertension that stretches veins and damages valvess
106
s/s of venous insufficiency
leg edema, stasis dermatitis, stasis ulcers
107
Varicose veins
distended protruding veins
108
treatment for varicose veins
Elastic compression hose exercise elevation

MedSurge 3 (28 decks)

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