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nurs pathophysiology > rrd 6 > Flashcards

rrd 6 Flashcards

disorders of peripheral vascular system pt 1

1
Q

right side of the heart

A

venous - deoxygenated flowing is coming in from all veins and tissues in the body

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2
Q

left side of the heart

A

arterial side - oxygenated flow going out via aorta to all arteries and tissues in body

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3
Q

forward flow is _____; _____ _____ can cause “back-up” flow.

A

normal, various pathologies

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4
Q

basic path of blood

A
  1. right atrium
  2. tricuspid valve
  3. right ventricle
  4. pulmonic valve
  5. pulmonary artery
  6. pulmonary arterioles
  7. pulmonary capillaries (gas exchange w/ alveoli occurs here)
  8. pulmonary venules
  9. pulmonary veins
  10. left atrium
  11. mitral valve
  12. left ventricle
  13. aortic valve
  14. aorta
    14a. fresh O2 blood goes into coronary arteries (branch off aorta valve and feed heart)
    14b. blood goes to brain tissue via carotids
    14c. rest to tissue beds of remainder of body
  15. arterioles of tissues
  16. capillaries (gas exchange w/ tissue occurs here)
  17. venules
  18. veins
  19. inferior vena cava (from body) or superior vena cava (from head)
  20. right atrium
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5
Q

right heart refers to

A

right atrium (RA) and right ventricles (RV) and valves

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6
Q

left heart refers to

A

left atrium (LA) and left ventricle (LV) and valves

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7
Q

chambers of the heart

A
  • LA
  • LV
  • RA
  • RV
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8
Q

receiving chambers or arteries has blood coming from? examples?

A
  • blood coming IN from elsewhere
  • EX: systemic arterial system (aorta, etc.) receives blood from the LV
  • EX: pulmonary arterial system (pulmonary artery, etc.) receives blood from the RV
  • EX: RV receiving chamber of blood from RA
  • EX: LV receiving chamber form the LA
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9
Q

heart cycle

A
  1. AV valves (tricuspid + mitral) open + ventricles fill with fluid
  2. as systole begins: AV valves close (lub sound) & pulmonic + aortic valves open
  3. pulmonic + aortic valves close (dub sound) & diastole begins
  4. ventricles begin to fill right after dub
  5. this is one heartbeat, or one “stroke” of the heart
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10
Q

blood in veins is almost always _______ and blood in arteries is almost always ________.

A
  • deoxygenated
  • oxygenated
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11
Q

the only arterial vessels in the body that carry deoxygenated blood are? what is its travel path?

A
  • pulmonary artery and arterioles
  • deO2 blood travels via pulm artery -> pulm arterioles -> pulm cap where CO2 diffuses out of cap -> into alveoli -> exhaled
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12
Q

the only venous vessels that carry oxygenated blood are? what is its travel path?

A
  • pulmonary venules and veins
  • pulm caps around alveoli receive O2 blood -> pulm venules -> pulm veins -> LA
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13
Q

cardiovascular refers to

A

heart and its vessels

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14
Q

peripheral vascular refers to

A

vessels outside the heart

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15
Q

circulatory system refers to

A

cardiovascular + peripheral vascular

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16
Q

general term “central”

A

heart, lungs, brain, kidneys - most crucial areas of the body

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17
Q

general term “peripheral” or “periphery”

A

outside the heart/lungs/kidneys/brain

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18
Q

stroke volume (SV)

A

amount of blood ejected per beat

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19
Q

goal of electrical and mechanical functions of heart

A

create effective cardiac output (CO)

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20
Q

cardiac output (CO)

A

avg amount of blood the LV ejects (and therefore, is in circulation) per minute

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21
Q

normal CO

A

4-6 L/min

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22
Q

formula for CO (and example with 80 bpm and 70 mL/beat…)

A
  • HR x SV
  • EX: 80 beats/min (HR) x 70 mL/beat (SV) = 5600 mL = 5.6 L/min
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23
Q

good CO has S/S of?

A
  • good perfusion: norm BP, pulses, capillary refill, mentation, skin color and warmth
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24
Q

good perfusion is a combo of good CO and?

A

healthy arteries: good vasomotor tone and patent lumen

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25
Q

cardiac output can improve or deteriorate by

A
  • changes in HR (and rhythm)
  • changes in SV which are affected by 3 other conditions
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26
Q

3 conditions that affected changes in SV

A
  • contractility of cardiac muscles (pump action)
  • preload (blood return to the heart)
  • afterload (arterial resistance to cardiac blood flow)
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27
Q

EKG/ECG (electrocardiogram)

A
  • a graph of the cardiac contractions generated from electrical pathway seen by placing specialized patches on the skin that act as negative and positive poles
  • each configuration reps depolarization and contraction of each part of the heart
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28
Q

heart rate

A

rate of impulses generated by the SA node and traveling throughout the heart

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29
Q

normal HR

A

60-100 bpm or impulses/minute (each impulse generates a contraction or beat)

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30
Q

norm and healthy: each impulses in a consistent, regular pattern of ________. normal heart rate and rhythm is also called?

A
  • PQRST
  • normal sinus rhythm (NSR or just SR)
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31
Q

SA node

A
  • SA: sinoatrial
  • SA node is near a venous sinus near the right atrium
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32
Q

heartbeat is the same as?

A
  • beat
  • ventricular contraction
  • systole
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33
Q

systole is the part of heart cycle in which _____ and ____ are _________ and ____ blood from their chambers into the pulmonary artery and the aorta, respectively.

A
  • RV and LV
  • contracting and ejecting
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34
Q

systole occurs between what?

A

lub (closure of AV valves) and dub (closure of pulmonic and aortic valves)

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35
Q

systole begins with an ______ signal generated by _____. it spreads throughout the atria to _______ to _______. as each cardiac muscle cell receives an ____ signal, it _____ and _____.

A
  • electrical
  • SA node
  • AV node
  • ventricles
  • electrical
  • depolarizes and contracts
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36
Q

systole results in?

A
  • ventricular contraction
  • simultaneous ejection of blood from RV -> pulmonary vasculature / LV -> systemic vasculature
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37
Q

stroke volume (SV) in context of systole

A

amount of blood ejected per contraction during every systole

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38
Q

average SV is?

A

70 mL/beat

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39
Q

diastole

A

part of the heart cycle in which RV and LV are receiving blood from RA and LA = filling with blood

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40
Q

preload

A

what comes to ventricles before contraction

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41
Q

heart muscle is like a rubber-band: the ____ it is stretched to a certain point, the _____ it will contract (Frank-Sterling Law)

A

more, better

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42
Q

the heart stretching is accomplished in the heart through?

A

filling the ventricles with blood

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43
Q

preload is related to the _____ of blood in the ventricles before contraction

A

volume

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44
Q

preload is considered normal when there is?

A

a normal amt of blood in circulation

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45
Q

if cardiac muscle normal and healthy, contractility is?

A

good

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46
Q

property of contractility includes

A

how well cardiomyocytes respond to electrical signals and contract (how effectively cardiac cells work together to eject blood, how toned heart muscle is)

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47
Q

inotropic

A

used to describe the effect of different factors of contractility

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48
Q

positive inotropic effect

A

something that enhances contractility of the heart

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49
Q

negative inotropic effect

A

something that decreases contractility of the heart

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50
Q

afterload

A
  • any form of resistance to ejection of blood from a heart chamber
  • resistance to forward flow of blood
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51
Q

a certain amt of afterload/resistance is ______. _____ afterload exists when the receiving arteries have:

A
  • normal
  • norm vasomotor tone (arterial walls have flexible, compliant, not too contracted/dilated muscle tone)
  • linings are smooth and patent
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52
Q

T/F: the heart as a whole has a normal afterload

A

FALSE: each chamber of the heart has its own norm afterload

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53
Q

normal RV afterload

A
  • norm status of pulm artery and its branches throughout the lungs
  • PVR: pulmonary vascular resistance
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54
Q

peripheral flow

A
  1. aorta
  2. major arteries in legs (ileac, femoral, popliteal)
  3. pedal arteries (DP, PT)
  4. arterioles of tissue beds of legs and feet
  5. capillary beds (gas exchange: O2 from B to T; CO2 from T to B)
  6. venules
  7. veins of feet and legs
  8. inferior vena cava
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55
Q

veins

A

thin-walled vessels that take deoxygenated blood from tissue beds all over the body back to the RIGHT side of the heart

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56
Q

venous return

A
  • flow back to the heart
  • aka venous drainage of tissues
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57
Q

conditions that facilitate good venous return and prevent backflow

A
  • proper functioning valves in leg veins
  • well-toned, working muscle tissue around the veins
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58
Q

leg vein valves during systole

A
  • blood is being pushed into arteries by the heart, the systolic pressure is also helping to push venous blood back towards the heart
  • vein valves in legs OPEN
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59
Q

vein valves during diastole

A

leg vein valves CLOSE so that blood doesn’t back flow and succumb to gravity

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60
Q

well-toned, working muscle tissue around the veins do what?

A
  • massage the veins
  • helps direct flow towards heart during systole
  • helps prevent backflow during diastole
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61
Q

arm veins and most other veins in the body have ______, but since there is not such a _____ problem to fight against, it is not as common to have __________ in the ____.

A
  • valves
  • gravity
  • venous disease
  • arms
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62
Q

most venous disorders occur _____ and usually have to do with some degree of failure to keep entire amt of ______ flowing in its proper direction, which is?

A
  • in the legs
  • venous blood
  • upward, towards the heart
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63
Q

venous congestion

A

venous blood staying and settling out in the veins of the leg and foot tissues

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64
Q

factors contributing to venous congestion

A
  • gravity “winning”
  • valve incompetence
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65
Q

example of gravity winning contributing to venous congestion

A

being on your feet too long can cause gravity to pull fluid downward into distal leg tissues (normal experience - not really pathological)

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66
Q

______ hydrostatic pressure can also cause ______ pressures to _____ veins that they can become twisted and distorted - what are these veins called?

A
  • increased
  • backflow
  • surface
  • varicose veins
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67
Q

are varicose veins harmful?

A

not usually a health hazard but can become painful and cosmetically distressing to patients

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68
Q

valve incompetence in venous congestion

A

when this is a problem, a pathology is involved = venous insufficiency

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69
Q

hydrostatic pressure in blood vessels is?

A

force exerted by a fluid (blood) against the wall of the vessel

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70
Q

concept map of chronic venous insufficiency (CVI)

A
  1. floppy valves
  2. increased hydrostatic pressure distal to bad valves bc venous blood can’t return up to heart properly
  3. engorged peripheral veins
  4. pushes fluid out to tissues
  5. edema
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71
Q

edema causes what kind of S/S for CVI?

A

swollen, tight, dry, discolored skin that can easily get traumatized and ulcerated

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72
Q

CVI most often caused by leg vein valves _____ and becoming _____. what do they mean by these characteristics?

A
  • wearing out, floppy
  • don’t close tightly during diastole, allowing backflow into distal veins of legs/feet (venous congestion)
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73
Q

venous stasis

A
  • pool of non-moving blood in veins seen in the congestion from CVI
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74
Q

venous stasis results in?

A

increased hydrostatic pressure inside the affected veins

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75
Q

the increased hydrostatic pressure from venous stasis in CVI ______ fluids into tissues of legs/feet, causing?

A
  • pushes
  • edema in the affected area
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76
Q

the edema in CVI causes ______ discomfort, but over time, can also cause?

A
  • mild to moderate
  • dry, tight skin often w/ brownish discolorations
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77
Q

when the area becomes to engorged with edema in CVI, what happens?

A
  • skin cells cannot fxn properly
  • tissue easily breaks down (esp over bony prominences like heels, ankles, coccyx)
  • = venous stasis ulcers
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78
Q

contributing factors to development of CVI

A
  • aging
  • inherited predisposition
  • obesity
  • sometimes, pregnancy (esp multiple)
  • job related issues (years standing)
  • lack of assistance from musculature (poor muscle tone due to immobility and/or inactivity)
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79
Q

deep vein thrombosis (DVT)

A

clot that develops on the wall of a vein, most of the time, in deep veins (not usually surface veins) on thighs and calves

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80
Q

once DVT develops, the vein and entire area around vein can become?

A

inflamed and swollen (thrombophlebitis)

81
Q

S/S DVT

A
  • local redness, pain, warmth, edema (ie, inflammatory signs)
  • usually seen only unilaterally (in one leg)
  • can be extreme or hardly noticeable
  • also may have no S/S at all
82
Q

those at highest risk for DVT have one or more elements of _______/

A

Virchow’s triad

83
Q

Virchow’s triad

A
  • injury to endothelium of vein
  • stasis of blood flow
  • hypercoagulability states
84
Q

stasis of blood flow in Virchow’s triad

A
  • can be from underlying venous disorder such as CVI
    and/or
  • inactivity of muscles surrounding the veins
85
Q

hypercoagulability states in Virchow’s triad

A
  • caused by some degree of dehydration (less H2O in blood, blood more conc, clotting factors + platelets can find each other easily to cause pathologic clotting
  • can be due to individual tendencies to clot more easily (coagulopathy)
86
Q

situations where Virchow’s triad (one or more) is present

A
  • sit a lot or for long periods
  • casts or other immobilizing devices on legs
  • bed-ridden or wheelchair-bound
  • pregnant
  • obese
  • on meds like diuretics (dehydration) or certain hormone therapy like BCPs (estrogen increase levels of certain clotting factors)
  • pre-existing problems like circulation issues (CVI) and/or clotting problems and/or recent surgery
87
Q

possible dangerous sequela of DVT

A

PE - pulmonary embolus

88
Q

if thrombus or part of one break free from an existing DVT, it can then become a venous ______.

A

embolus

89
Q

pattern of travel for PE

A
  1. DVT of leg
  2. IVC
  3. RA
  4. RV
  5. PA
  6. usually gets stuck in tiny pulmonary arterioles
90
Q

____ of people w/ DVT develop PE

A

30%

91
Q

S/S PE

A
  • chest pain
  • SOB
  • hemoptysis (blood in sputum)
  • shock (low blood pressure causing poor perfusion)
92
Q

concept map linking patho S/S of PE

A
  1. embolus enters pulm artery to smaller arterioles where it gets stuck
  2. blocks deO2 venous blood from getting to alveoli to get O2 - SOB
  3. irritates arterial intima - inflammation - leak of blood into lung tissue - hemoptysis
  4. large portion of lung tissue inflamed - massive release of inflamm mediators - systemic vasodil - shock (low BP)
93
Q

treatment (nursing implications) of venous problems

A
  • encourage mobility
  • encourage hydration during period of immobility (prevent DVT)
  • elevate legs/feet to increase venous return
  • be careful of skin breaks
  • blood thinners (heparin and/or coumadin and/or aspirin) used to prevent more clotting
94
Q

arteries

A

thick-walled, muscled vessels that accept O2 blood from the heart and circulate to tissue beds all over the body

95
Q

the ability of arteries to work efficiently in maintaining flow of ____ blood from heart to tissues determined by?

A
  • oxygenated
  • muscle tone of their walls
  • state of their lumens
96
Q

the muscle tone of the arterial wall is also called?

A

vasomotor tone

97
Q

part of arterial walls are made of ________ which respond to various influences and needs of the body.

A

muscle cells/fibers

98
Q

the muscular elements of the arterial wall can _____ and ____ as needed, and in general, maintain a certain ______ to the vessel.

A
  • constrict and dilate
  • muscle tone
99
Q

arteries with normal, good muscle tone are?

A

flexible, compliant, not too constricted, not too dilated

100
Q

having good ___ is often dependent on having just right vasomotor of the arteries.

A

BP

101
Q

perfusion is?

A

process of delivery of O2 and nutrients via atrial system to tissue beds all over body

101
Q

state of lumen

A

healthy lumen lining is smooth and patent (open) - free of blockage so forward blood flow is smooth, uninterrupted

101
Q

good vasomotor tone and patent lumen contribute to

A

good perfusion of distal tissues

102
Q

good/bad perfusion results in good/bad tissue ______ and is determined by _____ and other factors such as _________.

A
  • oxygenation
  • cardiac output
  • state of arterial vessels
103
Q

S/S associated w/ good perfusion

A

desired BP range of 110/60 to 115/70 (norm is under 120/80)

104
Q

BP is a measurement of ________ in the arteries or arterial system. the pressure is the _____ exerted ____ the walls of the arteries by the blood passing through them. BP is determined by how much ____ there is in the arteries. a more elastic/stretchy artery will offer?

A
  • fluid pressure
  • force, against
  • resistance
  • less resistance
105
Q

systolic pressure

A

pressure in the arteries that is exerted when heart is contracting and ejecting blood out to the arteries (systole)

106
Q

diastolic pressure

A

pressure existing in the arteries when the heart is between systoles, or filling (not moving blood around - resting) (diastole)

107
Q

BP is measured with?

A

arm cuff and sphygmomanometer: machine that shows pressure in mm of mercury (Hg) as it rises or goes down

108
Q

when a BP cuff is pumped around the arm, it occludes the _________; as pressure is released, the pressure at which the first sound is heard is?

A
  • brachial artery
  • pressure in the arteries during systole in mmHg
109
Q

when the cuff pressure continues to go down and becomes ____ than the diastolic pressure, ___ pulse is heard; when the sounds stop, the cuff pressure at that point indicates?

A
  • less
  • no
  • the pressure in the arteries during diastole
110
Q

relationship of BP to arterial tone

A
  • pressure of fluid in a container is higher if the walls of the container are rigid and have no give
  • the more relaxed the walls of the container, the lower the pressure of the fluid in it
111
Q

pluses

A

pulsations in the arterial system that occur with every heart contraction

112
Q

where can the pluses be easily palpated?

A
  • carotid pulses in neck
  • radial pulses in wrist
  • pedal pulses (dorsalis pedis (DP) on top foot and posterior tibialis (PT) on medial side next to malleolus)
113
Q

there is a range of _____ or ____ in their strength and quality with pulses

A

normality or abnormality

114
Q

pulse barely palpable vs pulse bounding means what?

A

pulse difficult to feel/weak or very easy to feel/strong?

115
Q

normal capillary refill

A
  • nail blanching
  • how quickly does atrial system refill empty capillaries
    -norm is < or equal to 2 secs (arterial system is efficiently refills capillaries in <2 secs)
116
Q

normal organ function, S/S

A
  • skin: pink or usual color, warm
  • heart: good cardiac fxn
  • brain: good mentation (norm mental activity)
  • kidneys: good urine output
117
Q

arterial diseases aka _____ because commonality in all of them is?

A
  • arterial insufficiency
  • insufficient amt of O2 getting to distal tissue (ischemia)
118
Q

arterial insufficiency is almost always due to ____, a process in which?

A
  • atherosclerosis
  • arteries become stiffer and collect fat and other unwanted substances in their walls
119
Q

arteriosclerosis

A

chronic disease of arterial system usually related to aging, in which artery walls become thick and hardened

120
Q

over time, arterial vessels are increasingly damaged by?

A
  • hypertension (HTN)
  • smoking
  • diabetes
  • infection
  • high cholesterol
  • genetics, free radicals, reg aging
121
Q

w/ arteriosclerosis: as the intima (inner lining) of the arterial walls become microscopically _______, _______ enter the walls and stiffen them.

A

damaged, collagen fibers

122
Q

collagen fibers entering the walls decreases what?

A
  • elasticity of arteries
  • compliance of arteries
    ^ pathologically alters vasomotor tone
123
Q

almost always, as arteriosclerosis develops, there is also ______ involvement.

A

atherous (fatty deposit)

124
Q

collagen fibers and ______ collect in arteriosclerotic walls.

A

LDLs - become fatty deposits

125
Q

when fatty deposits enter the arterial wall, tissue becomes ? and _____ responses are triggered.

A
  • irritated
  • inflammatory and coagulatory
126
Q

plaque

A

fibrous capsule w/ fatty middle section in the wall of the artery

127
Q

combo of stiff arteries, fat deposits, and inflammatory and clotting responses ultimately leads to?

A

plaque

128
Q

as plaque grows, it ____ into the arterial lumen, thus _______, and often the ______ is enough to ____ blood flow to distal tissues.

A
  • protrudes
  • reducing its patency
  • reduce
129
Q

atherosclerosis develops mostly bc?

A

unneeded cholesterol in the blood, esp extra LDLs

130
Q

lipids (triglycerides and cholesterol) cannot?

A

travel in watery blood to get to cells

131
Q

lipids must combine with ____ to form water-soluble molecules called?

A

proteins, lipoproteins

132
Q

VLDL

A
  • large conc of triglycerides, some cholesterol and phospholipid, and very low conc of protein
  • VLDL carried in blood to cells - trigly dropped off for storage - lipoprotein becomes LDL
133
Q

LDL

A
  • mostly cholesterol
  • deliver cholesterol to cells
  • excess cholesterol refused by cell, so can pile up in walls of vasculature
134
Q

HDL

A
  • at least 50% protein, small amt cholesterol and phopholipids
  • good fat bc pick up extra cholesterol from cells and deliver to liver for processing
  • delivers availability of cholesterol for use in fatty plaques that clog arteries
135
Q

plaque formation with atherosclerosis are almost always _______.

A
  • system-wide
  • found in one area, almost always going on anywhere in the body that arteries are found
136
Q

alteration in vasomotor tone and non-patent lumen causes?

A

ischemia to distal tissue due to constant constriction/brittleness and build-up of blockage material

137
Q

end result of most arterial disorders is _______, which results in _____.

A
  • compromised perfusion (delivery)
  • ischemia (hypoxia of tissues caused by an arterial circulation problem)
138
Q

S/S of ischemic pain due to decreased perfusion and ischemia

A
  • pain characteristic of increasing with exertion and diminishing with rest
  • exertion causes more O2 demand on tissue that is barely getting enough O2 even at rest
139
Q

the ischemic pain will be in the tissue _____ to the plaque and/or arterial narrowing

A

distal

140
Q

example of ischemic pain distal to plaque and/or arterial narrowing

A
  • femoral arteries are affected - pain in valves, esp when patient walks
  • coronary arteries affected - pain in distal muscle tissue of heart - chest pain
141
Q

S/S of decreased perfusion and ischemia that is?

A

specific to part of body affected

142
Q

where can decreased perfusion and ischemia specific to body part affected be seen?

A
  • periphery (mainly arteries in arms, legs)
  • heart
  • brain
  • kidneys
143
Q

periphery affected by decreased perfusion and ischemia looks like?

A
  • pulses: diminished/absent
  • delayed capillary refill: >2 secs
  • skin pale, cool, sometimes mottled or blueish
  • sometimes delayed healing
144
Q

in people of color, pallor is not as obvious if their periphery is affected due to decreased perfusion and ischemia. what does it manifest as?

A

duskiness under their normal coloring and paleness of mucous membranes

145
Q

why is less color seen in the skin when there is decreased perfusion and ischemia?

A

arterial narrowing or blockage

146
Q

example of delayed healing due to decreased perfusion and ischemia

A
  1. low perfusion to skin
  2. abrasion to skin doesn’t heal bc no O2
  3. worsens into ulceration (ischemic skin ulcer)
147
Q

heart S/S due to decreased perfusion and ischemia

A

altered fxn, usually less cardiac output

148
Q

brain S/S due to decreased perfusion and ischemia

A

altered level of consciousness, stroke (brain doesn’t get enough O2 and brain tissue damage)

149
Q

kidney S/S due to decreased perfusion and ischemia

A

diminished urine output

150
Q

non-modifiable risk factors of arterial diseases

A
  • family history (ex: inherited tendency toward atherosclerosis and/or familial hypercholesterolemia)
  • advancing age = stiffer arteries
151
Q

modifiable risk factors of arterial diseases

A
  • diet/obesity/sedentary lifestyle - more LDLs circulating
  • heavy alcohol consumption = toxic byproducts affecting arterial walls
  • Type II DM (modifiable to a degree)
  • cigarette smoking
152
Q

TYPE II DM risk factor with arterial disease

A
  • toxic # of glucose molecules will damage affect arterial walls
  • lipodystrophy: DM2 characteristic in which there is increased circulating LDLs
153
Q

cigarette smoking risk factor of arterial disease

A
  • toxic byproducts damage arterial walls
  • nicotine powerful vasoconstrictor - pathologically narrows arteries and increases BP/HR
154
Q

peripheral arterial disease (PAD)

A
  • peripheral arterial insufficiency
  • a disease of any arterial vessels outside of heart, but PAD most commonly applied to arterial problems of legs
  • manifests as problems of ischemia due to narrowed, peripheral arteries
  • S/S in legs
155
Q

S/S of PAD

A
  • pain
  • pale
  • diminished pulses
  • feet cool to touch
  • no hair on legs, skin shiny
  • ischemic skin ulcers
156
Q

5 Ps of PAD (S/S)

A
  • pain
  • paresthesia
  • pallor
  • pulselessness
  • poikilothermia
157
Q

pain S/S PAD

A
  • ischemic pain in muscles of legs which may cause limping
  • occurs and is exacerbated w/ exercise and decrease with rest
  • intermittent claudication
158
Q

diminished pulses S/S PAD

A

prolonged cap refill of >2 secs

159
Q

ischemic skin ulcers S/S PAD

A

skin is not fed enuf O2, becomes more fragile and traumatizes easily

160
Q

associate distal congestion with _____ slow-flow and/or blockage; associate distal ____ with arterial slow-flow and/or blockage

A
  • venous
  • arterial
161
Q

arterial thromboembolic problems

A
  • arterial thrombi from where flow is sluggish
  • and/or where there is narrowing of vessels
  • and/or injuries in vessel walls
162
Q

when veins get blocked, flow ____ the heart is blocked, leading to a type of _____ and tissue ____ distal to blockage.

A
  • towards
  • back-flow
  • congestion
163
Q

when arteries get blocked, its problem of distal tissue is ______.

A

ischemia

164
Q

examples of distal tissue ischemia due to artery blockage

A
  • narrowing/injury/atherosclerosis @ bifurcation of femoral arteries = thrombus might form - part of thrombus (clot) broke free = travel to distal peripheral arteries arterioles such as in feet
  • five Ps seen in distal tissue (pain, paresthesia, pallor, pulselessness, poikilothermia)
165
Q

avg desired BP

A

110/70

166
Q

BP over 130/80 is ____ while BP under 90/60 is ___.

A

hypertensive, hypotensive

167
Q

hypertension (HTN)

A

the consistent elevation of systemic arterial blood pressure, measured with sphygmomanometer as BP w/ norm/optimal being about 110/70

168
Q

2 general etiological categories of HTN

A
  • secondary HTN
  • primary HTN
169
Q

secondary HTN

A
  • uncommon
  • caused by altered hemodynamics associated w/ disease process such as adrenal tumor, renal problems
170
Q

primary HTN

A
  • caused by complex set of factors
  • essential or idiopathic HTN
  • 92-95% of all hypertensives have this
171
Q

demographics, risk factors of primary HTN

A
  • 3rd leading cause of death bc widespread effect on almost all body organs
  • risk factors for HTN same for atherosclerosis
  • high diet intake of sodium - water retention - higher pressure in circulatory system
172
Q

HTN can lead to ____ and vice versa.

A

atherosclerosis

173
Q

primary HTN is linked to many factors in various combos, but certain conditions usually present to some degree such as:

A
  • atherosclerosis
    and/or
  • overactivity of sympathetic nervous system
    and/or
  • overactivity of RAAS
174
Q

pathophysiology of primary HTN also includes

A

atherosclerosis - narrowing, brittleness, and fatty infiltration of arteries can contribute to developing HTN in the same way that pressure is higher in an old, stiff garden hose with no give

175
Q

overactivity of SNS as a pathophysiology of primary HTN can be due to

A
  • overt or subtle, sustained, psychological and/or physical stressors (fight or flight)
    and/or
  • genetic predisposition
176
Q

overactivity of RAAS as pathophysiology of primary HTN

A
  • NORM: RAAS compensatory system that is usually activated when DROP in BP = vasocon and increased blood vol to increase BP
  • w/ primary HTN: RAAS chronically overactive - cause chronically elevated blood volume and pressure
177
Q

primary HTN is due to several mechanisms including:

A
  • genetic predisposition
  • sympathetic NS and/or RAAS in constant overdrive state
  • simultaneous effect of atherosclerosis
178
Q

the several mechanisms causing primary HTN results in

A

pathologic increase in cardiac output and arterial vasoconstriction = pathologic increase in BP

179
Q

S/S of HTN are often _____ to vascular damage done by years of ______ in the arteries of various organs.

A
  • secondary
  • pounding of increased pressure
180
Q

often takes _____ of S/S of vascular damage to show up - why HTN is called?

A
  • many years
  • submarine of diseases; silent but deadly
181
Q

HTN most often affects the arterial vasculature of 3 primary systems:

A
  • neurological system
  • renal system
  • cardiovascular system
182
Q

effects of HTN on neurological system

A
  • brain: strokes; loss of fxn in parts of brain due to ischemia from narrowed arterial vessels + high pressures
  • eyes: narrowing of tiny arterioles in retina = ischemia and infarct of retina parts = vision changes
183
Q

effects of HTN on renal system

A
  • high pressures + damage to renal arteries can cause blood spill and/or protein into urine (hematuria, proteinuria) = renal failure
184
Q

effects of HTN on cardiovascular system

A

increased workload on heart as it tries to eject blood against narrowed, stiff arteries and higher BP can cause multiple types of heart problems like heart attacks

185
Q

aneurysms

A

localized dilation or outpouching of arterial vessel wall

186
Q

patho of aneurysms

A
  1. atherosclerosis + usually HTN weaken arterial walls
  2. create bulges in certain areas
  3. minute injuries to intimal lining accumulate and allow blood to seep from lumen into layers of arterial muscle + tissue
  4. increasing size of aneurysm and danger of rupture
187
Q

areas of typical aneurysms

A
  • brain
  • aorta
188
Q

aneurysms in brain

A

if leaks or ruptures, can cause S/S of stroke:
- weakness on one side of body
and/or
- change in level of consciousness
and/or
- sudden horrific headache

189
Q

aneurysms of aorta

A

particularly susceptible to aneurysms due to constant stress on vessel wall - esp from higher pressures of HTN

190
Q

S/S aortic aneurysm

A
  • if gradually develops + stays small = may not have S/S
  • AAA (abdominal aortic aneurysm): found by routine physical exam of abdomen - pulsatile mass palpated; sometimes abdominal and/or back pain
  • thoracic aortic aneurysm: found accidentally by x-ray; S/S resemble heart attack - chest and/or back pain
191
Q

treatment (nursing implications) of arterial problems

A
  • non-medicinal approaches
  • medicinal approaches
  • bedside/nursing interventions
192
Q

non-medicinal prevention/treatment of arterial problems

A
  • manage stress, stop smoking, moderate alc
  • nutritious diet w/ salt in mod and good management of fat intake (low LDLs, high HDLs and omega-3 fats)
193
Q

LDLs can be lowered via _____. HDLs can be raised via _____.

A
  • low-fat diet and meds
  • exercise, red wine, somtimes niacin
194
Q

omega-3 fats (found in ____) can also be considered good fat because?

A
  • flaxseed, fish oil
  • helps to fight inflammation that is integral part of atherosclerotic process
195
Q

medicinal approach to treat arterial problems

A
  • combat overactive SNS: beta-blockers
  • combat vasoconstrictive activity of RAAS: ACE inhibitors (ACEI)
  • decrease chance of pathologic clots: blood thinners like aspirin, coumadin, heparin
196
Q

bedside/nursing interventions for arterial problems include

A
  • monitor pulses and BP trends
  • monitor tissue and gen oxygenation (check cap refill)
  • watch for/prevent skin breaks
197
Q

would you elevate feet for someone with peripheral arterial problem like you would do for venous problem?

A

no - make it even harder for oxygenated blood to get to feet

nurs pathophysiology (13 decks)

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