Care of Patients with HTN and VTE/DVT

Question 1

Hypertension

Answer 1

most common health problem seen in primary settings. AHA 2017 guidelines below 130/80

Question 2

desired BP in 60 yo and older

Answer 2

below 150/90

Question 3

desired BP in younger than 60 yo

Answer 3

below 140/90

Question 4

desired BP in patients with DM and heart disease

Answer 4

below 130/90

Question 5

BP elevations…

Answer 5

results in damage to organs, causes thickening of the arterioles, as the blood vessels thicken, perfusion decreases and body organs are damaged

Question 6

HTN is a major risk for…

Answer 6

stroke, myocardial infarction, kidney failure, death

Question 7

Classifications of HTN

Answer 7

primary and secondary

Question 8

primary classification of HTN

Answer 8

most common type, not caused by an existing health problem: can develop when a patient has any one or more of the risk factors: family history, African American ethnicity, hyperlipidemia, smoking, older than 60 or postmenopausal, excessive sodium and caffeine intake, overweight/obesity, physical inactivity, excessive alcohol intake, low potassium, calcium or magnesium intake, excessive and continuous stress.

Question 9

secondary classification of HTN

Answer 9

results from specific diseases and some drugs. kidney disease is one of the most common causes of secondary HTN

Question 10

physical assessment/clinical manifestations of HTN

Answer 10

most people have no symptoms, some patients experience headaches, facial flushing (redness), dizziness, fainting, blood pressure screenings (take in both arms, two or more readings at a visit, use appropriate size cuff)

Question 11

orthostatic hypotension

Answer 11

decrease in BP with changes in position, 20 mmHg for systolic and or 10 mmHg for diastolic

Question 12

psychosocial considerations for HTN

Answer 12

assess for stressors that can worsen HTN

Question 13

Diagnostic assessment for HTN

Answer 13

no specific lab or x-rays are diagnostic of primary hypertension. secondary hypertension can be screened with labs specific to the underlying disease
ex: kidney disease

Question 14

interventions for HTN

Answer 14

lifestyle changes, complementary and alternative therapies, drug therapy, avoid OTC medications (NSAIDS, decongestants)

Question 15

lifestyle changes for HTN

Answer 15

dietary sodium restriction to less than 2g per day, reduce weight, use alcohol sparingly, exercise 3-4 times a week for 40 min, use relaxation techniques to decrease stress, avoid tobacco and caffeine

Question 16

complementary and alternative therapies for HTN

Answer 16

biofeedback and meditation

Question 17

Drug therapies for HTN

Answer 17

diuretics, calcium channel blocker, angiotensin converting enzyme (ACE) inhibitor, angiotensin II recpetor blockers (ARBs), Aldosterone receptors antagonists, beta adrenergic blockers,

Question 18

Venous Thromboembolism VTE

Answer 18

includes deep vein thrombosis DVT and pulmonary embolism PE

Question 19

Risk factors for VTE

Answer 19

stasis of blood, vessel wall injury, altered blood coagulation
VIRCHOW’S TRIAD

Question 20

VTE prevention

Answer 20

prevention is key to address this challenge in health care: patient education, leg exercises, early ambulation, adequate hydration, graduated compression stockings, intermittent pneumatic compression, such as SCDs, venous plexus foot pump, avoid oral contraceptive, anticoagulant therapy

Question 21

Symptoms of DVT

Answer 21

may be symptomatic or asymptomatic
classic s/s: calf or groin tenderness and pain AND sudden onset of unilateral swelling of the leg
induration (hardening) along the blood vessel
warmth, edema, redness
checking a Homan’s sign is not advised because it is an unreliable tool
physical exam findings may be adequate for diagnosis.

Question 22

preferred diagnostics test for DVT

Answer 22

venous duplex ultrasonography: assess flow of blood through the veins of the arms and legs

Question 23

lab testing for DVT

Answer 23

negative D-dimer test can exclude a DVT. used for the diagnosis of DVT when the patient has few clinical signs

Question 24

goals for DVT interventions

Answer 24

prevent pulmonary emboli, further thrombus formation, or an increase in size of the thrombus.

Question 25

symptoms of a pulmonary emboli

Answer 25

SOB, chest pain, acute confusion

Question 26

intervention for DVT

Answer 26

elevate legs when in bed and chair, do not massage the effected extremity, drug therapy (anticoagulants: heparin, enoxaparin, warfarin)

Question 27

Unfractionated Heparin Therapy (UFH)

Answer 27

Baseline PT, aPTT, INR, CBC with platelet count
antidote: protamine sulfate
heparin-induced thrombocytopenia (HIT)- life threatening complication

Question 28

Low Molecular Weight Heparin (LMWH)

Answer 28

Preferred for prevention and treatment of VTE
antidote: protamine sulfate
May see an overlap of enoxaparin and warfarin given for treatment of DVT or PE

Question 29

Non pharmacological interventions for DVT

Answer 29

thrombolytics and surgical management

Question 30

Warfarin

Answer 30

given PO
monitor PT and INR
Assess for bleeding
antidote: vitamin K
teach patients to avoid foods with high concentrations of vitamin K

Question 31

Which of the medications taken by Mrs. Adams places her
at increased risk for the development of DVT?
– 1. Antibiotics
– 2. Analgesics
– 3. Bronchodilator
– 4. Oral contraceptives

Answer 31

4

Question 32

Which physical assessment should
the nurse perform to assist in the
diagnosis of suspected DVT?
–1. Measure calf circumference
bilaterally
–2. Observe for excessive bruising
–3. Perform test for Homan’s sign
–4. Auscultate for bruits

Answer 32

1

Question 33

It is shift change. The oncoming nurse
enters the room and notices observable
hematuria in Mrs. Adam’s urinary
catheter.

• What action should the nurse initiate
  first?
  –1. Obtain a stat aPTT
  –2. Stop the heparin infusion
  –3. Assess vital signs
  –4. Observe the surgical site for bleeding

Answer 33

2

Question 34

After consulting with the HCP, the
nurse is to administer a heparin
antagonist.
*
* Which medication will be
administered?
–1. Vitamin K
–2. Protamine Sulfate
–3. Enoxaparin (Lovenox)
–4. Ticlopidine (Ticlid)

Answer 34

2

Question 35

To which nursing diagnosis should
the nurse give the highest priority
when planning care for Mrs. Adams?
– 1. Pain related to decreased venous flow
– 2. Risk for injury (bleeding) related to
anticoagulant therapy
– 3. Impaired physical mobility related to
prescribed bedrest
– 4. Knowledge deficit related to lack of
discharge teaching

Answer 35

2

Question 36

Mrs. Adams is transitioned to warfarin
by mouth. Mrs. Adams should receive
additional teaching about foods

• Which food should the nurse instruct
  Mrs. Adams to avoid?
  –1. Apple products
  –2. Red meats
  –3. Green leafy vegetables
  –4. Nuts

Answer 36

3