HTN, PVD, PAD Flashcards by Daisy Perez

The largest artery in the body

Aortic artery

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Factors that affect blood pressure

Peripheral resistance, vessel elasticity, blood volume, cardiac output

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The volume of blood pumped by each side (ventricle) of the heart in one minute

Cardiac output

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Resistance of blood vessels to blood flow

Peripheral resistance

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The total amount of blood in the circulatory system

Blood volume

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Components of the blood

Nutrients and oxygen

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Decreased blood volume causes __________, while elevated blood volume causes _________

Dehydration & hypotension; hypertension

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Peripheral vascular disease (PVD) most commonly affects the

Extremities; particularly the lower extremities

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Volume of blood pumped by each ventricle in one contraction (heartbeat)

Stroke volume (SV)

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How much blood is pumped out of the left ventricle with each heartbeat?

~ 70 mL

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Typical heart rate

75 bpm

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Ways to increase cardiac output

Increase SV, increase HR, or increase both

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Cardiac output equation

CO = SV x HR

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Blood pressure equation

Blood pressure (P) = Cardiac output (Q) x vascular resistance (R)

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Which two factors are interconnected through the hemodynamic regulation of blood pressure?

Cardiac output and hypertension

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Hypertension that is developed over time

Primary or essential

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Risk factors for primary/essential hypertension

Genetics, smoking, obesity, high salt intake, high alcohol consumption, stress, lack of exercise, aging

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Hypertension that occurs quickly and more severely

Secondary

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risk factors for secondary hypertension

Obstructive sleep apnea, heart defects, kidney disease, medications or illegal drugs, adrenal/thyroid conditions

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Hormone that is released when the body senses that BP and/or blood volume is low

Renin

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Renin triggers

Angiotensin

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Angiotensin signals __________ to retain sodium and water when BP is low, or release sodium and water when BP is high

Aldosterone

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Electrolyte imbalance associated with ACE inhibitors

Hyperkalemia (release of sodium and water, retention of potassium)

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Cardiac complications of HTN

Coronary artery disease —> angina or MI, left ventricular hypertrophy, HF

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Brain complications of HTN

TIA, stroke, cognitive impairment, vascular dementia

Kidney complications of HTN

Chronic kidney disease (CKD), end-stage renal disease (ESRD)

Eye complications of HTN

Hypertensive retinopathy —> damage to retinal blood vessels, vision impairment, blindness

Blood vessel complications of HTN

Atherosclerosis, PAD, increased risk of aneurysms and vascular complications

Nervous system complications of HTN

Peripheral neuropathy (particularly in individuals with poorly controlled HTN)

Atherosclerosis/PVD/PAD risk factors

Aging, genetics, gender, hyperlipidemia, HTN, smoking, DM, lack of exercise, stress, obesity

Chronic inflammatory disorder that causes build up of cholesterol plaques on medium and large arteries

Atherosclerosis

Loss of arterial elasticity through the hardening and thickening of arterial walls

Arteriosclerosis

Most common cause of PAD

Atherosclerosis

Most common arteries affected by atherosclerosis

Abdominal aorta, coronary, popliteal, carotid

PAD pathophysiology

Hardening of fatty deposits in arteries narrow the opening and block effective blood flow

An umbrella term for disorders affecting blood vessels outside the heart and brain

Peripheral vascular disease (PVD)

A specific type of PVD where plaque buildup occurs in arteries carrying blood to extremities, especially the legs

Peripheral artery disease (PAD)

S/S of PVD

Pain or discomfort in legs, cramping, numbness, weakness, skin color/temp changes

S/S of PAD

Intermittent claudication, cold feet, reduced hair growth on legs

PAD can progress to

Critical limb ischemia

Diagnosis for PVD and PAD

Medical history, physical, and imaging tests such as ultrasound and angiography

PVD/PAD treatment

Lifestyle changes, medications (to control risk factors), possible procedures such as angioplasty and surgery

First diagnostic test for PAD

Ankle brachial index (ABI) test

Recommendation for mild to moderate PAD

Lifestyle modifications

Normal/no PAD as determined by ABI

>0.9

Mild PAD as determined by ABI

0.8-0.9

Moderate PAD as determined by ABI

0.3-0.7

Critical PAD as determined by ABI

<0.3

A arterial condition affecting blood flow to certain parts of the body, often fingers and toes

Raynaud’s Disease

Rare disease affecting small and medium sized arteries and veins in the arms and legs

Buerger’s Disease

Cause of Raynaud’s

Cold or stress triggers episodes, causing small artery narrowing

Cause of Buerger’s

Strongly associated with tobacco use

S/S of Raynaud’s

Episodic color changes (white, blue, red), numbness, tingling during episodes

S/S of Buerger’s

Pain, tenderness, skin changes, ulcers, potential progression to gangrene

Age and gender risk factors for Raynaud’s

Can affect anyone, more common in women and people in colder climates

Age and gender risk factors for Buerger’s

Affects young males more

Raynaud’s management

Lifestyle changes, avoiding triggers, medications

Buerger’s management

Smoking cessation, medications for vasodilation, surgical interventions (severe cases)

Raynaud’s prognosis

Generally manageable with lifestyle changes and medications

Buerger’s management

Severity can lead to amputation; smoking cessation critical!!

Arterial narrowing or occlusion (arteriosclerosis) which causes decreased O2 and nutrients to the lower extremities

PAD

Pooling of blood in the extremities due to the inability to bring blood back to the heart (vascular insufficiency)

Peripheral venous disease

S/S of PAD

1) Sharp pain, 2) absent pulse, 3) skin: cool to touch, pale, shiny, absent hair, thin, dry, scaly, no edema, 4) Lesions: red sores on toes and feet with punched out appearance, 5) gangrene (death of tissues)

S/S of peripheral venous disease

1) dull, achy pain, 2) presence of strong pulse, 3) skin: edema, warm legs, yellow/brown ankles, 4) irregular shaped sores/lesions, 5) no gangrene

Patient positioning for PAD

Hang/dangle the patients legs (remember: an “A” shape for PAD)

Patient positioning for peripheral venous disease

Elevate patients legs (remember: v shape for PVD)

Pathogenesis of PAD

Endothelial dysfunction (impairment of arterial lining d/t HTN or DM), inflammatory response, plaque formation, plaque rupture (risk for clot formation), ischemia and tissue damage, thrombosis and embolism, collateralization

Attempted compensation by developing new blood vessels

Collateralization

PAD lifestyle modifications

Healthier diet, smoking cessation, exercise, lose weight

Anti-platelet agents to reduce the risk of blood clots in PAD

Aspirin, clopidogrel (Plavix)

Cholesterol lowering agents to control and slow progression of atherosclerosis in PAD

-statins (atorvastatin)

PAD medications to reduce cardiovascular risk

Antihypertensives

PAD medication for improving claudication symptoms and walking distance

Cilostazol

Pain management medications for PAD

Acetaminophen or NSAIDs

PAD endovascular surgical intervention used to dilate narrowed arteries and improve blood flow

Ballon angioplasty

PAD endovascular surgical intervention that provides structural support to the treated artery and prevents re-narrowing

Stent placement

PAD endovascular surgical intervention that removes plaque from arterial walls

Atherectomy

PAD surgical revascularization that reroutes blood flow around blocked arteries, using autologous grafts or synthetic material

Bypass surgery

PAD surgical revascularization that removes atherosclerotic plaque from the inner lining of the artery to restore blood flow

Endarterectomy

PAD surgical intervention for severe cases with tissue necrosis or non-healing ulcers

Amputation

Nursing assessment for PAD

Vascular assessment — peripheral pulses, skin color, temperature, capillary refill time; assess for pain, claudication, and ulceration

PAD patient education regarding foot care

Regular inspection and moisturization

PAD nursing wound care

Cleaning, debridement, dressing changes, monitor for s/s of infection

How to correctly take BP

Choose correct cuff size for patient’s arm circumference, support arm at heart level with cuff at the same level as the heart, take multiple readings and use an average for accuracy

Factors that can cause an elevated blood pressure reading

Not allowing the patient to rest for at least 5 minutes before measurement, speaking or moving during the measurement

At what rate should the nurse deflate the cuff when measuring blood pressure?

2-3 mmHg per second

Elevated blood pressure due to anxiety in a medical setting

White coat hypertension

How to prevent inaccurate BP measurements in a patient with A.fib or irregular heartbeat

Use automated monitors that account for irregular heart rhythms or average multiple measurements

Improving blood flow to tissues and organs

Revascularization

Procedure commonly performed on carotid arteries to reduce stroke risk

Endarterectomy

Surgical removal of blood clot and atherosclerotic material to restore blood flow, typically performed in cases of acute arterial occlusion

Thromboendarterectomy

Patient education for warfarin (Coumadin)

Regular blood work, goal INR: 2.5 (2.0-3.0), s/s of toxicity include easy bruising and bleeding

First sign of sepsis

Tachycardia

Sepsis interventions

Establish IV access (18 gauge), fluid resuscitation, antibiotics

HTN, PVD, PAD Flashcards

(94 cards)