2.2 Cardiovascular, vascular Flashcards
(37 cards)
Anemia
Abnormally low # of circulating RBCs, decreased Hgb concentration or both
R/T acute/chronic blood loss, inadequate RBC production or increase in RBC destruction
May affect all major organ systems depending on severity
Risk increases with age
Categorized by cause
Anemia Pathophysiology
Decreased oxygen carrying capacity of blood r/t deficiency of RBCs or Hgb = tissue hypoxia
Manifestations depend on severity, how quickly it develops, other factors
S/Sx develop as RBC & Hgb continue to decrease
Blood redistribution to vital organs & lack of Hgb = pallor of skin, MM, conjunctiva, nailbeds
Tissue oxygenation decreases = HR & RR increases trying to increase cardiac output & tissue perfusion
Rapid Blood Loss
- Blood volume rapidly decreases which decreases oxygen carrying capacity of blood
- Tachycardia, tachypnea, skin pale cool & clammy, poss signs of circ shock
Pathophysiologic Mechanisms of Anemia
Decreased RBC Production
Decreased RBC Production
Altered Hgb Synthesis
- Iron Deficiency
- Thalassemias
- Chronic inflammation
Altered DNA Synthesis
-Vit B12 or Folic Acid malabsorption or deficiency
Bone Marrow Failure
- Aplastic Anemia
- Red Cell Aplasia
- Myeloproliferative leukemias
- Cancer Metastasis, lymphoma
- Chronic Infection, inflammation, physical & emotional fatigue
Pathophysiologic Mechanisms of Anemia
Increased RBC Loss or Destruction
Increased RBC Loss or Destruction
Acute or Chronic Blood Loss
- Hemorrhage or trauma
- Chronic GI bleeding, menorrhagia
Increased Hemolysis
- Hereditary Cell membrane disorder
- Defective Hgb=sickle cell dx or trait
- PK deficiency
- Immune mechanisms/disorders
- Splenomegaly
- Infection
- Erythrocyte trauma (d/t CABG)
Nutritional Anemias
Iron Deficiency Anemia
Iron Deficiency Anemia
- Most common type of anemia
- Supply of iron is inadequate to make Hgb
- Results in fewer number of RBCs
- Usually caused by excessive iron loss d/t chronic bleeding
- Inadequate diet or malabsorption may also be cause
Manifestations:
- Chronic iron deficiency
- Brittle, spoon shaped nails
- Cheilosis (cracks at corner of mouth)
- Smooth, sore tongue
- Pica(person eats things not usually considered food)
Nutritional Anemias
Vitamin B 12 Anemia
Inadequate B12 is consumed or poorly absorbed from GI tract
- Pernicious Anemia = failure to absorb dietary B12
- Malabsorption
- Dietary factors (vegans)
Manifestations:
- Pallor
- Slight jaundice
- Weakness
- Smooth, sore beefy red tongue
- Diarrhea
- Neurologic symptoms
Nutritional Anemias
Folic Acid Deficiency
Folic Acid Deficiency
Folic Acid: green leafy veggies, fruit, cereal, meats & absorbed in intestines
Caused by:
-Inadequate Dietary Intake
Older adults, alcoholics, TPN
-Increased Metabolic Requirements
Pregnant, Infants/Teens, HD, hemolytic anemia
-Folic Acid Malabsorption & Impaired Metabolism
Celiac sprue, Chemo agents, Alcoholism
Manifestations:
- Pallor
- Progressive weakness & fatigue
- SOB, Heart palpitations
- Similar to B12
- Glossitis, cheilosis, diarrhea but NO Neuro S/Sx
Anemia Diagnostics
Diagnostics CBC Iron Level Serum Ferritin Schilling Test Cobalamin
Anemia Medications
Medications Dependent on cause Iron replacement -Black stools/constipation Cobalamin Folic Acid Dietary modifications
Polycythemia
Polycythemia
Excess of RBCs characterized by Hct > 55%
Impaired circulation due to increased blood viscosity
Primary Polycythemia (Polycythemia Vera)
-Uncommon, cause unknown
-Overproduction of RBCs, WBCs, platelets
-Mostly affects men of Euro Jewish ancestry btw 40-70
Secondary Polycythemia
- More Common
- Increased # of RBC d/t excess EPO secretion or prolonged hypoxia
- Usually develops as response to chronic hypoxia
Polycythemia Manifestations
Increased Blood Volume & Viscosity = Manifestations
HTN common = HA, dizziness, vision & hearing disruptions
Venous stasis: plethora (ruddy color), itching of fingers/toes
Retinal engorgement
Hypermetabolism = weight loss, night sweats
Altered mental status = drowsiness, delirium
Splenomegaly (primary only)
GI bleeding
Intermittent claudication
Thrombosis
Management of Polycythemia
Primary Polycythemia Vera
Primary Polycythemia Vera Perform phlebotomy (500ml) Monitor I & O -hydration Prevent stasis & DVT exercise, ASA Meds (leukemia risk)
Management of Polycythemia
Secondary Polycythemia
Secondary Polycythemia Controlling chronic pulmonary disease Smoking cessation Avoid high altitudes Monitor I & O, hydration Prevent stasis & DVT
Venous Thrombosis
Blood clot forms on wall of vein, accompanied by inflammation of vein wall & some degree of obstructed venous blood flow
Superficial or deep veins
Venous Thrombosis Factors Associated
Factors Associated: Immobilization Surgery Cancer Trauma Pregnancy & Delivery Hormone Therapy Coagulation Disorders
Venous Thrombosis Pathophysiology
Virchow’s Triad
Stasis of blood flow
Endothelial injury
Hypercoagulability
Venous Thrombosis Manifestations
Dull, aching pain in affected extremity
Possible tenderness, warmth, erythema along vein
Cyanosis & edema in affected extremity
Chronic venous insufficiency
PE
Venous Thrombosis Management Diagnostics
Diagnostics
Duplex Venous US
Plethysmography
MRI
Ascending Contrast Venography
Venous Thrombosis Management Prophylaxis
Prophylaxis
Low molecular weight heparins
Oral
Elevate foot of bed, knees slightly flexed
Early mobilization & leg exercises
IPCs & TEDs
Venous Thrombosis Management Medications
Medications
Thrombolytics
- Streptokinase or tPA
- May accelerate clot lysis & prevent damage to valves
Anticoagulants
- Main treatment
- Prevent clot extension
- Enable body’s own lytic system to dissolve clot
- Reduce risk of PE
- Heparin infusion started calculated by aPTT
- Warfarin may be started with heparin infusion
- LMW Heparin used more frequently
Peripheral Artery Disease (Arterial Insufficiency)
Atherosclerosis = ischemia of extremities (distal legs); Decreased sensation = Increased risk of injury
Risk Factors:
Age, males, heredity smoking, obesity, inactivity, HTN, hyperlipidemia, DM
Peripheral Artery Disease (Arterial Insufficiency) Manifestations
Manifestations
Leg pain when walking relieved by rest (intermittent claudication)
Rest pain
Paresthesias
Diminished or absent peripheral pulses
Pallor with extremity elevation, dependent rubor when dependent
Thin, shiny, hairless skin; thickened toenails
Areas of discoloration or skin breakdown
Peripheral Artery Disease (Arterial Insufficiency) Management Diagnostics
Diagnostics Stress Testing Duplex Doppler US Angiography MRA
Peripheral Artery Disease (Arterial Insufficiency) Management Medications
Medications
Platelet aggregate inhibitors (ASA, Plavix)
Pentoxifylline decreases blood viscosity
Vasodilators
