Care of Pt. with vascular problems Flashcards
(61 cards)
1
Q
hypertension
what can it lead to?
A
- High Blood Pressure (BP)
- Can lead to Stroke, MI, Kidney Failure, Death
2
Q
AHA recommendations for hypertension
A
Maintain BP less than 130/80
3
Q
JNC Recommendations
for hypertension
A
Over 60
- Maintain BP less than 150/90
Under 60
- Maintain BP less than 140/90
4
Q
Arterial baroreceptor system
A
- Receptors located primarily in the carotid sinus, aorta, and left ventricle
- Alter HR, Vasoconstrict and Vasodilate
5
Q
Regulation of body fluid volume
A
- Excess fluid – Rise in Cardiac Output → Increased BP
- Fluid Deficit – Decrease in Cardiac Output → Decreased BP
6
Q
Renin-angiotensin-aldosterone system
A
- Kidneys recognize change in blood pressure/volume, oxygen levels and osmolarity
- Secrete renin when one of these becomes low → Triggers hormonal and blood vessel responses to raise BP
- *When BP is high secretion of renin should decrease
7
Q
Vascular autoregulation
A
Ability of organ to maintain blood flow despite changes in BP
8
Q
essential hypertension
& risk factors
A
- Most common, no known cause
- Results in damage to vital organs d/t thickening of arterial walls causing decreased perfusion
Risk factors
- Obesity, smoking, stress, family history
9
Q
secondary hypertension
A
Occurs as a result of a disease state or as an adverse effect from some medications
10
Q
hypertensive crisis
A
also known as malignat hypertension
- Elevated BP that rapidly progresses
- Medical Emergency
- If not treated promptly can result in Kidney Failure, Left Ventricular Heart Failure and Stroke
11
Q
blood pressure in hypertensive crisis
A
- Systolic > 200 mm Hg
- Diastolic >150 mm Hg
12
Q
symtoms of hypertensive crisis
A
- Morning Headache
- Blurred Vision
- Dyspnea
- Uremia
- Substances normally eliminated in the urine accumulate in blood
13
Q
prehypertension stage of hypertension
A
120-139/80-89
14
Q
high stage of hypertension
A
Stage 1
140-159/90-99
Stage 2
> 160 / > 100
15
Q
Essential risk factors for HTN
A
- Family Hx
- African-American Ethnicity
- Hyperlipidemia
- Smoking
- > 60 Years Old
- Obesity
- Physical Inactivity
- Excessive Na or - Caffeine Intake
16
Q
secondary risk factors for HTN
A
- Kidney Disease
- Pregnancy
Medications - Estrogen (Oral Contraceptives) - Glucocorticoids - Methylprednisolone
17
Q
s/s of htn
A
- “Silent Killer”
- Headaches
- Dizziness
- Blurred Vision
- Angina
- Fatigue
- Dyspnea
18
Q
diagnosis of htn
A
Blood Pressure Readings
- Two or More elevated BP’s on separate days
Use the Correct Cuff
- Too Small – False High
- Too Big – False Low
19
Q
long term control decrease risk factors for
A
Stroke
MI
ESKD
Vision Loss
20
Q
lifestyle changes for htn
A
- Smoking Cessation
- Weight Reduction - Decrease Na Intake
- Restrict Alcohol consumption
- Increase Exercise
- follow Low-Fat diet
- Decrease Stress
21
Q
drug therapy changes for htn
A
- Individualized based on patient
- Often need two or more drugs for adequate control
22
Q
duiuretics
A
First drug of choice for managing HTN
Decrease BP by reducing blood volume
23
Q
diurtetics: potassium-sparing: Spironolcatone
A
- Prevent reabsorption of Na in exchange for K
- Risk for hyperkalemia
24
Q
diuretics: loop- furosemide
A
- Prevent/decrease Na reabsorption and increase water and K excretion
- Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
25
diuretics: thiazide: hydrochlorothiazide
- Prevent/decrease Na reabsorption and increase water and K excretion
- Use Cautiously in Older Adults: ↑ Risk for dehydration, orthostatic hypotension, falls
26
beta-blockers
- Drug of Choice for patients with Heart Disease
- Decrease BP AND Slow HR by blocking sympathetic nervous system
Common Examples
- Atenolol
- Metoprolol
27
Beta Blockers: Atenolol & Metoprolol
- Use Caution: Diabetics – May affect glucose production
- Do NOT Administer
HR < 50 bpm
Systolic BP < 90 mm Hg
28
Calcium Channel Blockers
- In combo with thiazide diuretics first-line therapy for African American patients
- Decrease BP and HR by interfering with movement of calcium through cell membrane
* *Results in vasodilation and blocks sinoatrial (SA) and atrioventricular (AV)node conduction
Common Examples
- Amlodipine
- Diltiazem
29
Calcium Channel Blockers: Amlodipine& Diltiazem
- Monitor BP/Pulse before Administration
- Use Cautiously: HF Patients
- Avoid Grapefruit juice
30
ACE inhibitors
- Angiotensin-Converting Enzymes
- Used as single or combination agents
- Decrease BP by preventing conversion of Angiotensin I to Angiotensin II
Preventing Vasoconstriction
Common Examples
- Lisinopril
- Enalapril
31
ace inhibitors: Lisinopril & Enalapril
- Monitor for S/S of HF
Edema
- Report dry cough
Most common side effect
32
ARBS
- Angiotensin II Receptor Antagonists
- Decreased BP by blocking the vasoconstrictor Angiotensin II at various receptor sites
Common Examples
- Valsartan
- Losartan
33
ARBS: Valsartan & Losartan
- Use Cautiously: Impaired renal function
- Monitor for Signs of Angioedema
Dyspnea, facial swelling
34
Home care management
stress compliance- no symptoms dosent mean BP is normal
35
self management
- Remind Patients suddenly stopping meds can result in rebound HTN
- Monitor and track BP at home
- Educate about Na restriction
- Teach about applicable modifiable risk factors
36
Health care resources
- The Red Cross
| - American Heart Association
37
Peripheral Arterial Disease (PAD)
affects arteries: blood vessels that carry blood away from the heart
38
peripheral venous disease
- affects veins: blood vessels that carry blood towards the heart
39
peripheral arterial disease
- Atherosclerosis – chronic, progressive arterial narrowing
- Results in reduced blood flow, ischemia develops
- Typically affects lower extremities
40
PAD risk factors
```
HTN
Hyperlipidemia
Diabetes
Smoking
Obesity
Sedentary Lifestyle
Family Hx
Female Sex
> 65 Years Old
```
41
subjective PAD
Intermittent Claudication
- Burning, cramping pain in legs during exercise
Numbness/burning sensation in feet when in bed
- Pain relief when in dependent position
42
objective PAD
- Decreased capillary refill
- Decreased/Non-palpable pulses
- Loss of hair on lower calf, ankle, foot
- Dry, scaly, mottled skin= robar
- Thick toenails
- Cold and cyanotic extremity
- Pallor of extremity with elevation
- Rubor (redness) of extremity
Ulcers
- End of Toes or Between Toes
- Pale w/ little granulation
* bad wound flow
43
6 p's of arterial disease
```
Pain
Pallor
Pulselessness
Paresthesia
Paralysis- numbness or tingling
Poikilothermia (coolness)
```
44
interventions of PAD
Promote Vasodilation
- Maintain warm environment, wear socks and avoid cold when possible
- Avoid caffeine and nicotine – cause vasoconstriction
Encourage Appropriate Positioning
- Do NOT cross legs
- Refrain from wearing restrictive garments: no ted stockings
- Cautiously elevate extremities
- Reduces swelling but above heart can cause significant slowing of arterial flow to feet
Medication Therapy
45
PAD medications
Antiplatelet Medications
- Reduce blood viscosity and decrease clotting mechanisms to increase blood flow
Examples
- Aspirin, Clopidogrel (Plavix)
Monitor s/s of bleeding
May take weeks for effectiveness to be apparent
Statins
- Lower cholesterol, decrease risk for plaque build up
Examples
- Simvastatin
- Atorvastatin
46
pad surgical management
Balloon Angioplasty
- Balloon dilation with or without stent placement
Atherectomy
- Removal of plaque
Bypass
- Autologous
- Graft
47
perioheral venous disease patho
Problems with the veins that interfere with adequate return of blood flow from the extremities which results in blood stasis
48
3 major disorders with pvd
Venous thromboembolism (VTE)
- Clot Formation
- Can break off (Emboli)
Venous Insufficiency
- Skeleton muscle doesn’t contract to help pump blood in veins
Varicose Veins
- Defective (Incompetent) Valves
49
VTE: cause of venous stasis
Reduced Blood Flow
Dilated Veins
Decreased Muscle Contraction
Faulty Vein Valves
50
vte: damage to vein lining
IV Catheters, Venipuncture
51
VTE: what causes increased blood coagulation
```
Abrupt Stop of Anticoagulant
Smoking
Oral Contraceptives
Estrogen Therapy
Hematological Disorders
```
52
virchows triange
venous stasis
damage to vein linning
increased blood coagulation
* have to have all 3 to have a vte
53
subjective cues for PVD
Painful/fullness/heaviness in legs after standing
54
objective clues for pvd
- Calf or groin pain/tenderness
- Warmth, edema, changes in calf circumference
- Brown discoloration
- Distended visible veins
- Cramping Muscle Aches
- Ulcers @ Ankle
55
PVD: taking action for a VTE
- Encourage ambulation after anticoagulation therapy initiated
- Warm moist compress
- Do NOT massage affected limb
56
PVD: taking action for venous insufficiency
- Avoid crossing legs
- Elevate legs for 20min, 4-5/day
- Elevate legs above heart when in bed
57
PVD meds
anticoagulation
antiplatelet
thrombolytic
58
pvd meds: anticoagulation
- Prevent or delay coagulation → Preventing clot formation
- Also known as blood thinners
Examples
- Heparin – Monitor PTT
- Lovenox
- Coumadin – Monitor INR
- Eliquis
- Xarelto
59
pvd meds: antiplatelet
Decrease platelet aggregation → Prevent agglutination →Prevent clot formation
Example
- ASA- asprin
- Plavix
60
pvd meds thrombolytic
Dissolve or break up existing clots → Open vessel and help prevent future clot formation
Examples
- Heparin
- Lovenox
61
pvd surgical interventions
Vena Cava Filter
- Filter that traps emboli before it gets to lungs
Vein Stripping
- Removal of large varicosities
