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Flashcards in Care of Patients with Vascular Problems Deck (59)
1

Arteriosclerosis:

thickening, hardening of the arterial wall that is often associated with aging

2

Atherosclerosis:

type of arteriosclerosis, involves the formation of plaque w/in the arterial wall and is the leading risk factor for cardiovascular disease

3

Palpate each carotid artery separately to

prevent blocking blood flow to the brain

4

What indicates hypertriglyceridemia?

level of 160 mg/dL or above in men
Women should have level below 135

5

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

6

Physical activity Arteriosclerosis

3-4 X a week

7

Drug therapy: Arteriosclerosis

3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors = reduce cholesterol

8

Complementary therapies: Arteriosclerosis

Nicotine acid or niacin
B vitamin
lower LDL-C
very low density lipoprotein (VLDL)
Increase HDL-C levels

9

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

11

Changes in fluid volume also affects the

systemic arterial pressure

12

Keeps perfusion in the body relatively constant, appears to be important in causing hypertension

Vascular autoregulation

13

the most common type of hypertension and is not caused by existing health problem

Essential (primary)

14

Primary hypertension results in

damage to vital organs by causing medial hyperplasia of the arterioles

15

Secondary hypertension=

specific disease states and drugs can increase person's susceptibility to this

16

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

18

Etiology and genetic risk =

Kidney disease: renal artery stenosis (RAS)
Primary aldosteronism
Pheochromocytomas
Cushing's syndrome
Drugs

19

Adrenal mediated hypertension is due to

primary excesses of aldosterone

20

Primary aldosteronism, excessive aldosterone causes

hypertension and hypokalemia

21

Pheochromocytomas:

tumors that originate most commonly in the adrenal medulla and result in excessive secretion of catecholamines

22

Cushing's syndrome:

excessive glucocorticoids are excreted from the adrenal cortex

23

Drugs that cause secondary hypertension

estrogen
glucocorticoids
mineralocorticoids
sympathomimetics
cyclosporine
erythropoietin

24

Manifestation of hypertension:

headaches
facial flushing
dizziness
fainting

25

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

26

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

27

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

28

hypertensive crisis:

severe elevation in BP (greater than 180/120) can cause organ damage in kidneys and heart

29

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

30

PAD results of

systemic atherosclerosis: partial or total arterial occlusion, decreases perfusion in lower extremities

31

Patho of PAD:

Inflow obstructions involve the distal end of the aorta and the common, internal, and external iliac arteries

32

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

34

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

35

Dependent rubor may occur when

the extremity is lowered

36

Arterial ulcers develop on the

toes (more of the big toe)

37

Imaging assessment for PAD:

MRA (angiography)
CTA

38

Other diagnostic assessment for PAD:

Doppler probe
ABI (less than 0.9 = PAD)
Exercise tolerance test
Plethysmography

39

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

40

Interventions for PAD:

first must be assessed to determine if the altered tissue perfusion is due to arterial disease, venous disease, or both

41

Nonsurgical management for PAD:

Collateral circulation: provides blood to the affected area through smaller vessels that develop and compensate for the occluded vessels

42

Drug therapy for PAD:

Antiplatelet agents
Do not eat grapefruit or juice

43

Invasive nonsurgical procedures: PAD

percutaneous vascular interventions also called percutaneous transluminal coronary angioplasty (PTCA)
Artherectomy

44

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

45

Preop care for PAD

baseline vitals

46

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

47

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

48

Emergency thrombectomy (removal of the clot):

the surgeon may perform at the bedside, most common treatment for acute graft occlusion

49

DVT presents a greater risk for

PE, a dislodged blood clot travels to the pulmonary artery - a medical emergency

50

stasis of blood flow, endothelial injury, and or hypercoagulability, known as

Virchow's triad

51

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

52

Precautions of DVT:

Avoid oral contraceptives
Hydrate
Exercise

53

DVT symptoms:

calf or groin tenderness and pain and sudden onset of unilateral swelling of the leg

54

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

55

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)

56

To prevent DVT while on unfractionated heparin:

low doses subcutaneously for high risk patients

57

Recommendations for people discharged with DVT=

Compliance w/ meds
dietary advice
Follow up monitoring
Info about adverse reactions

58

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

59

Foods to take with Warfarin=

Small amounts of Vit K:
Broccoli
Cauliflower
Spinach
Kale
Other green leafy vegetables
Brussel sprouts
Cabbage
Liver