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Nurs 2800 > Perfusion Chronic ex 2 > Flashcards

Perfusion Chronic ex 2 Flashcards

(103 cards)

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1
Q

Major risk factors for HTN

A

Sodium
Older age
African americans

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2
Q

what are they symptoms of HTN

A

none

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3
Q

symptoms related to target organ damage are seen late what are they

A

Retinal and other eye changes
renal hypertrophy
cardiac hypertrophy
Stroke
MI

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4
Q

Medical management for HTN

A

prevent complications and death by achieving and maintatingin bp

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5
Q

steps to improve HTN (management)

A

Lifestyle modifications
first line antihypertension (thiazide and ACE
Second line antihypertensives (beta blockers etc)

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6
Q

for older >65 adults what is their systolic goal

A

<130 systolic because of normal changes with aging

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7
Q

how do thiazide meds work

A

decreases volume - pee out fluid

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8
Q

what electrolyte are we worried about with thiazide

A

potassium

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9
Q

ace inhibitor

A

blocks A1 from converting to A2

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10
Q

aldosterone

A

makes your body retain fluid and sodium and lose potassium

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11
Q

adverse effect of ace inhibitor

A

cough
angioedema
hyperkalemia

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12
Q

ARB works by

A

Blocking aldoserone and a1
by blocking A2 receptors

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13
Q

Thiazide end in

A

thiazide

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14
Q

calcium channel blockers end with (and which ones dont)

A

-pine (HTN)
diltiazem (heart)
verapamil (heart)

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15
Q

Pregnant women first line medications because they cant have ACE or ARB medications

A

Calcium channel blockers (niphenidpine, lebatalol)

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16
Q

WHy cant pregnant women have ACE or ARB

A

angiotensin medications cause fetal defects

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17
Q

What to assess with HTN

A

BP, Symptoms for target organ damage (eye or retinal),
Risk factors (genes, smoking, health)
Lab tests: NOT DX and non specific (Urinalysis, blood chemistry, cholesterol, to find modifiable factors and is there damage)
Diagnostic procedures: again non specific, ECG, echocardiography

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18
Q

nursing hx and assessment for HTN

A

history and risk factors, assess potential symptoms of target organ damage, personal social and financial factors that will ifluence the condition or its treatment

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19
Q

Nursing Dx for HTN

A

deficient knowledge: regarding treatment and control of disease process

Nonadherence with therapeutic regimen: related to side effects of the therapy

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20
Q

collaborative problems and potential complications with HTN

A

target organs damage
MI
HF
LVH
TIA
CVA
Renal insufficiency and chronic kidney disease
retinal hemorrhage

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21
Q

planning and goals for HTN

A

understand disease process and treatment
they need to do self care
absence of complications
lower and controlling BP without adverse effects

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22
Q

interventions for HTN

A

education
reinforce and support lifestyle mods
taking medications as prescribed
Follow up that care

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23
Q

Diet for HTN

A

low sodium (<2400 mg or usuallly seen as <2G)

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24
Q

Lifestyle changes for HTN

A

exercise (30 minutes every day)
alcohol in moderation (women 1, men 2)
quit smoking
lose weight

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25
Evaluation and outcome
good BP <130 understand the disease adhere to the treatment plan stable labs (BUN and serum creatinine) no complications (no organ damage)
26
Gerontologic considerations in HTN
1. meds can be hard to remember to take (Set alarm) 2. expense 3. monotherapy to simplify taking meds understanding the regimen and physically can open and read the med containers 4. include family and care givers
27
Initial medication with uncomplicated HTN and no specific indications for another medication?
Go to medication -> Thiazide diuretic, and apparently ACE
28
Initial medication with uncomplicated HTN and patient is African American?
Calcium channel blockers
29
education plan for new HTN pain
30 minutse of regular aerobic physical activity reduce alcohol reduce sodium to 2400 mg BMI 18-25 (don't get Michelle started on this)
30
atherosclerosis symptoms
narrowed vessels in specific areas (heart = chest pain) cause the pain and issues
31
Complications of atherosclerosis
MI, HF, sudden cardiac death
32
risk factors
older adults but can happen in late teens male until women hit menopause cigarette smoking metabolic syndrome obesity diabetes and HTN * inflammatory markers homocysteine enzyme Cholesterol pannel
33
prevent artherosclerossis monitor
Cholesterol and lipid panels at the age of 20
34
LDL levels need to be less than
100
35
total cholesterol less than
200 mg/dl
36
HDL greater than
40 mg/dl for men and 50 for women
37
statins major complications
rabdo, myopathy, liver failure
38
Medication used for reducing cholesterol
Statins
39
Stable angina is
chest pain is brought on by increased oxygen demand that the body cannot achieve; pain relieved by rest
40
Unstable is
chest pain is brought on by increased oxygen demand that the body cannot achieve; pain NOT relieved by rest
41
Variant (prinzmetal) is
spasms cause pain
42
Silent angina
no signs or symptoms of heart ischemia
43
Who share symptoms
Angina and CAD
44
DX findings for angina
ECG LABS: CK, CKMB, troponin Stress test cardiac cath coronary angiography
45
medical management of angina
decrease O2 demand and provide O2 O2 drugs risk factors cath then cardiac rehab
46
medical management of angina
nitrates #1, vedy vedy fast BETA- blockers (LOL) CCBS (amlodipine and dilt Antiplatelet drugs anticoagulants
47
Nitrates are
vasodilators
48
Beta blockers
reduce myocardial oxygen consumption Inotropic and cronotropic
49
Beta blocker used for someone with COPD
Selective - otherwise really back for lungs
50
Calcium channel blockers (-PINE)
decrease chronotropic and inotropic phenoms, causes dilation
51
antiplatelet drugs for Angina
ASA and Clopidogrel (plavix)
52
Aspirin MOA
decrease ATP and current platelet formation
53
anticoagulant (heparin)
given to prevent subsequent thrombus
54
phases of cardiac rehabilitation
1 dx educate 2 after dischage exersise training 3 maintain exercise on own and longterm care
55
assessment and dx angina
pain assessment (SEE CHART 27-4)
56
Nursing dx for angina
risk for decreased cardiac tissue prefussion knowledge deficit anxiety
57
acute coronary syndrome aka
MI
58
Problems with angina
dysthythmias, CA, HF, MI, cardiogenic shock
59
What are nurses primary care plan for angina
decrease O2 demand and increase O2 Give o2 get rest
60
call light is on and the pt complains of chest pain
- stop what they're doing and rest (sit lay down) - Assess angina - VS, page someone for 12 lead ecg, get orders for nitro, and supplemental O2 - Reduce anxiety (imagery, music)
61
why do we give nitro 3x for chest pain
if not relieved by the 2nd or 3rd dose most likely not stable angina and if unstable angina might be MI
62
MONA acronym
Morphine, O2, Nitro, Aspirin
63
Reperfusion procedures for angina
percutaneous coronary intervention (PCI) Coronary artery bypas graft
64
PCI is and what is it used for
percutaneous coronary intervention is used to open occluded coronary artery to promote reperfusion
65
CABG
coronary artery bypass graft move the arteries around in heart to reperfuse
66
what causes altered vascular perfusion in arteries and veins
pump failure alterations in blood and lymphatic vessels circulatory insufficiency of extremities
67
What is worse (Acute or gradual) occlusion
sudden - no alternative pathways
68
changes occur distal to the level of obstructions so what are the priority manifestations of PAD
- intermittent claudication (pain with walking) - paresthesia (nerve endings don't get o2 so they start to tingle) - Shiny tight hairless skin with thickening toenails - pulses decreased/ absent - dependent rubor
69
what is elevation pallor
raise legs and further reduces perfusion in PAD
70
Rest pain
not even out of pain at rest and not perfusing
71
cilostazol
treats intermittent claudication
72
Drugs for PAD
treats intermittent claudication antiplatelet drugs (asa and clopidogrel) statin: decrease cholesterol and also help with
73
endovascular (radiologic) management
establish adequate inflow to the distal vessel by balloon angioplasty, stent, drug-eluting
74
Surgical management for PAD
reserved for severe and disabling claudication they do a balloon angioplasty and stent angioplasty OR they choose amputation
75
enastamosis
cut and redirect the vessel to another healthy one and sew it to that
76
Nursing asesssment for Arterial ulcers
Location: toes, feet, skin Appearance: Deep, pale Skin: normal atrophic, pallor when elevated; dependent rubor, thick, toenails, shiny and hairless skin Skin temp: cool No edema or very mild severe pain all the time gangrene may occur pulses decreased or absent, possible bruit
77
Shape of arterial ulcers
Nice and round
78
Art ulcers are
pulselessness, pain, pallor, poikilothermic,
79
whar are the planning goals once PAD has been established?
increase blood flow vasodilate with medications don't compress the goddamn legs adherence to self care plain
80
How to promote health with ART ulcers
warm not too hot not too cold heart healthy diet (low sodium, low fat, low cholesterol) exercise up until the intermittent claudication and then fucking stop medically managed exercises (ask a doctor)
81
promote arterial dilation as a nurse
- Dangle their feet - warm everything (not hot not cold) - no heat on lower extremities (no hot bath due to decreased sensation) - avoid trauma to lower extremities (wear shoes) - lotion not between the toes - diet
82
implimentation for arterial insufficiency
reduce further disease quit smoking weight loss BP<140/90 diabetics <130/80 Glycosylated hemoglobin <7.0 for diabetic meticulous foot inspection and care avoid heating blankets (KEEP THEM WARM NOT HOT)
83
Do people with peripheral venous disease experience pain?
not really, maybe achy, but not a perfusion issue so no pain
84
Virchows triad
venous stasis, hypercoagulability, endothelial injury
85
Risks for venous disease
varicose veings, cardiovascular disease
86
manifestations of PVD
Edema, Brown pigmentation of skin, aching of lower extremities, statis dermatitis, venous ulcrs
87
statsis dermatitis
a common type of eczema that develops in people who have poor blood flow.
88
Telltale sign of peripheral veous disease
Brown pigmentation of skin
89
area where PVD forms
Gator area (ankle biter area)
90
How to manage peripheral venous disease for chronic
reduce venous stasis and prevent ulcerations elevate feet, no prolonged sitting standing or walking
91
surgical management of PVD
- IVC filters (giant net for dvt) - vein stripping ligation (varicose veins) - sclerotherapy (inject a chemical to vein directly to collapse vein)
92
venous stasis ulcer assessment
Location: gator (medical/anterior ankle Ulcer appearance Superficial/ pink Skin brown discoloration, dermatitis, cyanosis Skin temp: normal Edema: may be significant Pain: usually mild; aching and dull Gangrene DOES NOT OCCUR pulses are normal
93
venous ulcers are more common than Arterial ulcers T/F
True
94
promote venous return and treat pain for PVD as a nurse
Graduated compression elevate extremity exercise (AROM/PROM massage pain meds anticoagulant/ thrombolytic therapy exudate management - wound vac
95
Evaluation of PVD?
did they do their things
96
intermittent claudication is gold star remember this Victoria for what disease
peripheral artery disease
97
what is initial assessment for PAD
Skin integrity leg color - up pale, down red toe nails - yuk ulcers?
98
medications for PAD
Aspirin, simvastatin, Ramipril (ACE inhibitor), pentoxifylline (intermittent claudication)
99
teaching people about asprin
take with food no babies
100
Teaching people about simvastatin
jaundice, GI effects NV and take with food
101
teaching people about Ramipril
angioedema and cough. take your BP and when to hold medication
102
Goal of medical management for HTN
To prevent complication and death by maintaining BP
103
What does the medication for HTN do
Decreases vascular resistance Blood volume Decrease strength heart contraction Decrease rate of heart

Nurs 2800 (16 decks)

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