Week Three Modules Flashcards
hypertension or high blood pressure can lead to the development of ________, meaning the risk of a heart attack ______
cardiovascular disease; increases
what are the requirements for a “normal” blood pressure category?
what are the requirements for a “elevated” blood pressure category?
systolic <120 mmHg & diastolic <80 mmHg
systolic 120 - 129 mmHg & diastolic <80 mmHg
what are the requirements for “stage 1” hypertension?
what are the requirements for “stage 2” hypertension?
systolic 130-139 mmHg or diastolic 80-89 mmHg
systolic of 140 or higher or diastolic of 90 or higher
what are the requirements for a hypertensive crisis?
the systolic BP is greater than 180 and/or the diastolic is greater than 120
if someone is experiencing a hypertensive crisis this means they should do what?
consult their doctor immediately
what is blood pressure?
the force exerted from the blood against the walls of the blood vessels
high blood pressure has a large _____ component
for example, if one of your parents have high blood pressure, your risk for having high blood pressure _____
genetic; increases
which race has the highest prevalence of hypertension in the world?
black americans
black women have a ________ of HTN than black men
higher incidence
black folks make _____ renin and don’t respond well to ______ drugs
less; renin-inhibiting
black americans typically have better blood pressure control with ______ and/or ______
calcium channel blockers; diuretics
when black folks are prescribed ACE inhibitors what is something we want to look out for?
angioedema
which population is less likely to receive treatment for HTN when compared to others?
latinos
Researchers have discovered that the prevalence of HTN among the Asian community was lowest among the _______ and highest among ________
chinese americans; filipino americans
what is atherosclerosis
atherosclerosis is often associated with ____
thickening or hardening of the arterial wall; aging
atherosclerosis, a type of arteriosclerosis involves the formation of _____ within the ____, and is the leading risk factor of what disease?
plaque; arterial wall; cardiovascular disease
the exact pathophysiology behind atherosclerosis continues to be investigated, but it is thought to occur from what?
damage to the vessel walls from HTN
after the blood vessels become inflamed from the constant bombardment of blood what happens?
afterwards, _____ migrates over the fatty streak forming a ______
a fatty streak appears on the inner lining of the artery
collagen; fibrous plaque
fibrous plaques are known to elevate and protrude into the vessels either causing ____ or ______ obstruction to _____
partial; complete; blood flow
plaques can either be ____ or ____
stable; unstable
stable plaques can ____ the vessel tissue and lead to _____ formation as part of the _____ mechanism
partially break; blood clot; repair
unstable plaques can “______” or break off from that area of the vessel and “_____” in a vessel forcing ____ of the arteries to occur
rupture; get stuck; obstruction; ischemia
what are some risk factors that can cause plaque formation?
weakened vessel walls due to HTN, natural process of aging, elevated fat/cholesterol, or cigarette smoking
what are some NON-MODIFIABLE risk factors for HTN?
age, gender, family history, and race
what are some signs and symptoms of HTN?
HTN is often asymptomatic until the blood pressure is severely high which causes end organ damage
a patient with SEVERE hypertension may display “______” which are secondary effects on the blood vessels
secondary signs
what are some examples of secondary s/s?
fatigue, dyspnea, or palpitations
can secondary symptoms happen to everyone with HTN?
no, the HTN must be considered severe
if someone is experiencing a hypertensive crisis what are some signs and symptoms we would expect to see?
severe headaches and nosebleeds
when it comes to medication adherence for HTN what are your biggest responsibilities as a nurse?
teach/explain the reason why the patient is taking the medication before administering the medication itself
as a nurse, teaching and explaining the adherence to BP medications helps to avoid what?
further damage to the vessels and organs which effectively reduces the pt’s chance of having a heart attack or stroke
when using the “teach back” method to check for understanding what are some questions you might ask your patient?
“what does this medication do?”; “why are you taking this medication?”
sometimes, providers will ask for ______ to determine the patient’s fluid status or if they are hypotensive
orthostatics
if a patient’s blood pressure prescription is too high what might we expect to see?
dizziness or shortness of breath when standing
do orthostatic blood pressures detect fluid loss LESS THAN 1L?
no
how do you perform orthostatic blood pressure measurements?
have the patient lay down on the bed and rest for about 5 minutes, then take a set of VS with the patient lying down, then assist the patient to stand up, then take another set of VS at 1 minute, and then again at 3 minutes
in order for a patient to be deemed as having “POSITIVE orthostatics” what are the criteria requirements?
decrease of 20 mmHg or more in the systolic blood pressure (SBP), or decrease of 10 mmHg or more in the diastolic blood pressure (DBP), or the HR increases by 20 bpm
if the patient reports feeling dizzy or light headed while taking the standing BP what should you do?
have the patient either sit down or lay down and abort the standing BP reading
according to the american heart association what are the Life’s Simple 7 ways to improve health and reduce the risk of HTN?
manage blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight, and stop smoking
MANAGING BLOOD PRESSURE:
it’s important to ____ your patients to take the prescribed medication everyday and address any ____ of taking the medication
educate; side effects
what is the main reason why many men won’t take their blood pressure medication?
because of erectile dysfunction
CONTROL CHOLESTEROL:
elevated LDL cholesterol can be reduced by what?
not eating as many animal products because they are the only foods that contain cholesterol
if your patient has very high cholesterol what might they be prescribed?
a “statin” medication such as atorvastatin
educate your patient that drinking more than _____ alcoholic drinks a day is risk factor for both ____ and _____
3; cardiovascular disease; stroke
encourage female patients to limit their alcohol intake to ____ per night
male patients should limit their alcohol intake to _____ per night
one drink; two drinks
______ is strongly associated with hypertension
excess alcohol
LOSE WEIGHT:
weight reduction has a significant effect of ______ blood pressure in many individuals
a rule of thumb is that for every ____ lost, the BP decreases by ___mmHg
reducing; 1kg; 1mmHg
EAT BETTER:
the dash diet encourages more ____ and ____, less ___, ____, and less sugar
fruits; vegetables; salt; red meat;
healthy adults should restrict their sodium (Na+) diet to ____mg per day
2000
patients who have been diagnosed with HTN, CVD, and diabetes should restrict their sodium (Na+) to ____ mg per day
1500
STOP SMOKING:
nicotine is known to cause _____ in blood vessels and ____ blood pressure
vasoconstriction; elevate
what is a major risk factor for cardiovascular disease?
smoking
what are other treatment options for high blood pressure?
monitoring BP at home; lifestyle modifications - weight reduction, moderation of alcohol consumption, and physical activity
what are some diuretics that can be used to treat HTN?
what is the ACE inhibitor that can be used to treat HTN?
furosemide; hydrochlorothiazide; aldactone
lisinopril
what is a beta blocker that can be used to treat HTN?
what is a angiotensin receptor blocker that can be used to treat HTN?
metoprolol; losartan
what is a calcium channel blocker that can be used to treat HTN?
amlodipine
what are complications of hypertension?
eye damage and chronic high blood pressure which can lead to arteriosclerosis, heart attack, and kidney failure
what is the most common cause of peripheral arterial disease?
where is the most common site for peripheral arterial disease?
atherosclerosis
femoral popliteal area
by the time symptoms of peripheral arterial disease appear how much (percentage wise) have the vessels narrowed?
75%
what are risk factors for peripheral arterial disease?
smoking, HTN, lipid abnormalities, age, gender, diabetes, and elevated c-reactive proteins
what are signs and symptoms of peripheral arterial disease?
intermittent claudication pain, pain at night, rest pain, and numb/aching pain
intermittent claudication pain is typically an ____ of peripheral arterial disease
pain at rest is typically a sign of _____ peripheral arterial disease
early sign; advanced
what are some “objective” signs of peripheral arterial disease?
cool extremities; absent/diminished pulses; cyanosis upon elevation; dependent rubor; thickened nails; and shiny skin
when the peripheral arterial disease is causing obstruction ABOVE the inguinal ligament what are some s/s we expect?
lower back, buttock, and thigh pain
when the peripheral arterial disease is causing obstruction BELOW the inguinal ligament what are some s/s we expect?
burning, cramping in the calves, ankles, and feet
do arterial ulcers bleed?
arterial ulcers typically have ____ drainage, are ____ in shape, and have ____ pain with cold temperatures
no, very minimal bleeding
minimal; round; increased
where are arterial ulcers typically found?
on the dorsum of the foot or toes
ANKLE BRACHIAL INDEX
what does the ankle brachial index measure?
what is considered “normal” ankle brachial reflex?
ankle systolic pressure/ brachial systolic pressure
1.00-1.30
if the ankle brachial index is between ___ to ____ then this is considered ____ PAD
0.90 - 0.71; mild
if the ankle brachial index is between ____ to ____ then this is considered _____ PAD
0.70 - 0.41; moderate
if the ankle brachial index is less than or equal to ____ then this is considered ___ PAD
0.40; severe
if you discover that your patient is suffering from ineffective tissue perfusion due to peripheral arterial disease what are some treatment options you could suggest?
structured walking program, avoid caffeine, avoid the cold, stop smoking, and avoid restrictive clothing
if you discover that your patient is suffering from pain due to peripheral arterial disease what are some treatment options you could suggest?
assess pain and administer analgesics, dressings, wound cleansing with warm fluids, deep breathing exercises, and dependent positioning
if you discover that your patient is suffering from impaired skin integrity due to peripheral arterial disease what are some treatment options you could suggest?
daily feet inspection; wearing shoes/slippers; toenail care by a podiatrist; possible surgery
what are some invasive treatment techniques for peripheral arterial disease?
balloon angioplasty; stent placements; embolectomy; or arterial grafts
when taking care of a patient who is post-op for their peripheral arterial disease treatment what must the nurse do?
monitor circulation to the extremity by checking things like the pulse/capillary refill, sensation, pain, and temperature
before the patient gets an amputation for PAD what is some pre-op teaching that must be done?
reinforce information that was given by the surgeon; for example, remind them the reason for the amputation; exercises they can perform to strengthen the upper extremities; and how to do post op care
when it comes to post-op care for an amputation you want to avoid sitting in a chair for more than ____ at a time, and lay on stomach about ____ times a day
1 hour; 3-4
after an amputation, should the patient place pillows under the surgical extremity?
no
what does discharge teaching for an amputation look like?
remind the patient to inspect the residual limb daily for signs of irritation; don’t wear the prosthesis if irritation is present; wash the limb with warm water and soap and then let it dry for 20 minutes; wear a limb sock that is clean and in good condition
what are the three functions of veins?
return blood from the periphery to the heart; regulate blood volume; exchange substances between tissues and blood
what are some skin changes that are found in peripheral VENOUS disease?
pitting edema in lower extremity and chronic cellulitis
what are s/s of peripheral VENOUS disease?
venous dermatitis and hyperpigmentation
when it comes to assessing a patient for peripheral venous disease what are some subjective symptoms that the patient will report?
leg heaviness, pain that improves with walking or elevation, and reporting that warmer temperatures tend to aggravate the symptoms
a peripheral venous wound that is “red” is considered to be what?
clean, healing, and contains granulation
a peripheral venous wound that is “yellow” is considered to be what?
possibility of infection, needs cleaning, is necrotic
a peripheral venous wound that is “black” is considered to be what?
necrotic, called eschar and may require surgery to lift it off the vascular bed
what are some nursing interventions for a patient who has a wound due to peripheral venous disease?
unna boot, leg elevation (elevate the legs above the heart), and compression stockings
what are some tips for patient education when it comes to peripheral venous disease?
avoid prolonged sitting/standing, use compression stockings, elevate legs above heart, hand wash your stockings
what are some subjective signs and symptoms of deep vein thrombosis?
what are some observations that could be used for charting on a patient with deep vein thrombosis?
history of dvt, heart failure, abdominal orthopedic surgery, obesity, or smoking,
unilateral edema, warm, red skin, elevated D-dimer
what are some nursing interventions to prevent deep vein thrombosis?
encourage ambulation, teach leg exercises to do in bed, administer low doses of heparin, educate the patient to avoid restrictive clothing, and encourage fluids for hydration
what are medications that can be used to treat a DVT?
heparin, warfarin, or INR at a therapeutic value of 2-3
when there is ineffective tissue perfusion with a DVT what are some things you want to avoid?
don’t massage the area and no SCD stockings
