Flashcards in Care of Patients with Vascular Problems Deck (59)
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Arteriosclerosis:
thickening, hardening of the arterial wall that is often associated with aging
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Atherosclerosis:
type of arteriosclerosis, involves the formation of plaque w/in the arterial wall and is the leading risk factor for cardiovascular disease
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Palpate each carotid artery separately to
prevent blocking blood flow to the brain
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What indicates hypertriglyceridemia?
level of 160 mg/dL or above in men
Women should have level below 135
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Recommendations for nutrition: Arteriosclerosis
Intakes of veggies, fruits, whole grains
Consume low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts
Limit intake of sweets, sugar-sweetened beverages, and red meats
5% to 6% of calories from saturated fat
Reduce trans fat
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Physical activity Arteriosclerosis
3-4 X a week
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Drug therapy: Arteriosclerosis
3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors = reduce cholesterol
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Complementary therapies: Arteriosclerosis
Nicotine acid or niacin
B vitamin
lower LDL-C
very low density lipoprotein (VLDL)
Increase HDL-C levels
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4 control systems play a major role in maintaining BP:
Arterial baroreceptor system
Regulation of body fluid volume
The renin angiotensin aldosterone system
Vascular autoregulation
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Found primarily in the carotid sinus, aorta, and wall of the left ventricle
arterial baroreceptors
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Changes in fluid volume also affects the
systemic arterial pressure
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Keeps perfusion in the body relatively constant, appears to be important in causing hypertension
Vascular autoregulation
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the most common type of hypertension and is not caused by existing health problem
Essential (primary)
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Primary hypertension results in
damage to vital organs by causing medial hyperplasia of the arterioles
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Secondary hypertension=
specific disease states and drugs can increase person's susceptibility to this
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a severe type of elevated BP that rapidly progresses
Malignant hypertension
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symptoms of malignant hypertension =
morning headaches, blurred vision, and dyspnea and/or symptoms of uremia (accumulation in the blood of substances ordinarily eliminated in the urine)
Diastolic pressure is greater than 150 mm Hg or greater than 130
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Etiology and genetic risk =
Kidney disease: renal artery stenosis (RAS)
Primary aldosteronism
Pheochromocytomas
Cushing's syndrome
Drugs
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Adrenal mediated hypertension is due to
primary excesses of aldosterone
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Primary aldosteronism, excessive aldosterone causes
hypertension and hypokalemia
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Pheochromocytomas:
tumors that originate most commonly in the adrenal medulla and result in excessive secretion of catecholamines
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Cushing's syndrome:
excessive glucocorticoids are excreted from the adrenal cortex
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Drugs that cause secondary hypertension
estrogen
glucocorticoids
mineralocorticoids
sympathomimetics
cyclosporine
erythropoietin
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Manifestation of hypertension:
headaches
facial flushing
dizziness
fainting
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Expected outcomes for hypertension:
Verbalize his or her individualized plan of care for hypertension
Expected to adhere to the plan of care, including making necessary lifestyle changes
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Interventions: Lifestyle changes for hypertension
Restrict sodium intake
Reduce weight
Use alcohol sparingly
Exercise 3-4 X a week
Use relaxation techniques to reduce stress
Avoid tobacco and caffeine
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Other Interventions: for hypertension
Complementary therapies: garlic and coenzyme Q10
Drug therapy: antihypertensives, Lipid-lowering treatment, diuretics (1st defense), calcium channel blockers, ACE inhibitors, aldosterone receptor antagonists, beta blockers, renin inhibitors
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hypertensive crisis:
severe elevation in BP (greater than 180/120) can cause organ damage in kidneys and heart
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Peripheral vascular disease (PVD):
disorders that change the natural flow of blood through the arteries through the arteries and veins of peripheral circulation, causing decreased perfusion to body tissues
Implies more arterial than venous
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PAD results of
systemic atherosclerosis: partial or total arterial occlusion, decreases perfusion in lower extremities
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Patho of PAD:
Inflow obstructions involve the distal end of the aorta and the common, internal, and external iliac arteries
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Classic leg pain known as
intermittent claudication
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Rest pain =
begin while the disease is still in the stage of intermittent claudication, is a numbness or burning sensation, often described as feeling like a toothache that is severe enough to awaken patients at night
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Patients with inflow disease:
have discomfort in the lower back, buttocks, or thighs
Mild: discomfort after walking about 2 blocks
Moderate: pain after walking one or 2 blocks
Severe: pain walking less than one block
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Dependent rubor may occur when
the extremity is lowered
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Arterial ulcers develop on the
toes (more of the big toe)
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Imaging assessment for PAD:
MRA (angiography)
CTA
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Other diagnostic assessment for PAD:
Doppler probe
ABI (less than 0.9 = PAD)
Exercise tolerance test
Plethysmography
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Patient with outflow disease:
describe burning or cramping in the calves, ankles, feet, and toes
Instep or foot discomfort indicates an obstruction below the popliteal artery
Mild: pain after walking 5 blocks
Moderate: pain after walking 2 blocks
Severe: cannot walk more than one-half a block
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Interventions for PAD:
first must be assessed to determine if the altered tissue perfusion is due to arterial disease, venous disease, or both
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Nonsurgical management for PAD:
Collateral circulation: provides blood to the affected area through smaller vessels that develop and compensate for the occluded vessels
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Drug therapy for PAD:
Antiplatelet agents
Do not eat grapefruit or juice
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Invasive nonsurgical procedures: PAD
percutaneous vascular interventions also called percutaneous transluminal coronary angioplasty (PTCA)
Artherectomy
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Surgical management: PAD
Arterial revascularization
Inflow procedures: bypassing arterial occlusions above superficial femoral arteries (SFAs)
Outflow procedures: surgical bypassing of arterial occlusions at or below the SFAs
Graft materials
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Preop care for PAD
baseline vitals
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Operative care PAD:
For open aortoiliac and aortofemoral bypass surgery: the surgeon makes a midline incision into the abdominal cavity to expose the abdominal aorta, with additional incisions in each groin
Open axillofemoral bypass: surgeon makes an incision beneath the clavicle and tunnels graft material subcutaneously with a catheter from the chest to the iliac crest, into the groin incision, where it is sutured in place
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Postop care PAD:
Deep breathing every 1-2 hr using an incentive spirometer are essential to prevent respiratory complications
NPO
Nurse marks the site where the distal pulse is best palpated or heard by Doppler
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Emergency thrombectomy (removal of the clot):
the surgeon may perform at the bedside, most common treatment for acute graft occlusion
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DVT presents a greater risk for
PE, a dislodged blood clot travels to the pulmonary artery - a medical emergency
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stasis of blood flow, endothelial injury, and or hypercoagulability, known as
Virchow's triad
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9 characteristics of DVT:
Active cancer, paralysis, or casting of extremity
Bedridden for more than 3 days
Major surgery with general anesthesia during the previous 3 months
Localized tenderness
Swelling of the entire leg
Calf swelling of greater than 3 cm larger than other leg
Pitting edema in one leg
Dilated superficial veins in one leg
Previous DVT
A score of 2 or more= likely to occur
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Precautions of DVT:
Avoid oral contraceptives
Hydrate
Exercise
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DVT symptoms:
calf or groin tenderness and pain and sudden onset of unilateral swelling of the leg
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preferred diagnostic testing for DVT:
Venous duplex ultrasonography, a noninvasive ultrasound that assess the flow of blood through the veins in the arms and legs
-Other: Doppler flow studies
Impedance plethysmography
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Interventions of DVT: nonsurgical management=
Rest
Drug therapy: Anticoagulants, unfractionated heparin therapy
Alternative to unfractionated heparine= low-molecular-weight heparin, warfarin therapy, thrombolytic therapy(fibrinolytics)
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To prevent DVT while on unfractionated heparin:
low doses subcutaneously for high risk patients
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Recommendations for people discharged with DVT=
Compliance w/ meds
dietary advice
Follow up monitoring
Info about adverse reactions
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Avoid w/ Warfarin=
Allopurinol
NSAIDs
Acetaminophen
Vit E
Histamine blockers
Cholesterol reducing drugs
Antibiotics
Oral contraceptives
Antidepressants
Thyroid drugs
Antifungal agents
Other anticoagulants
Corticosteroids
Herbs
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