Unit 3 Flashcards
1
Q
formula for BP
A
BP = CO x PVR
2
Q
PVR
A
peripheral vascular resistence
3
Q
formula for CO
A
CO = SV x HR
4
Q
SV
A
stroke volume
5
Q
CO
A
cardiac output
6
Q
normal BP
A
< 120 systolic
< 80 diastolic
7
Q
What makes HTN the silent killer?
A
pts are asymptomatic while damage is done
8
Q
HTN
A
> 120 systolic
> 80 diastolic
9
Q
Tx for HTN is initialized at what values for pts ≥ and < 60 yo?
A
- ≥ 60 yo: > 150/90
- < 60 yo: > 140/90
10
Q
categories of HTN
A
- essential
- secondary
11
Q
etiology of essential HTN
A
not caused by pre-existing condition
12
Q
etiology of secondary HTN
A
caused by pre-existing condition
13
Q
gender-related HTN risk factors
A
- < 45 yo: men > women
- 45-65 yo: men = women
- > 65 yo: men < women
14
Q
nonmodifiable risk factors for essential HTN
A
- > 60 yo
- postmenopausal
- family Hx
- African-American race
15
Q
modifiable risk factors for essential HTN
A
- physical
- overweight/obese
- hyperlipidemia
- diet: ↑ intake
- Na+
- caffeine
- ETOH
- lifestyle
- inactivity
- stress
- nicotine use
16
Q
risk factors for secondary HTN
A
- kidney dz
- primary aldosteronism
- pheochromocytoma
- Cushing’s
- coarctation of the aorta
- Brian tumors
- encephalitis
- PG
17
Q
meds that increase risk of secondary HTN
A
- estrogen
- glucocorticoids
- mineralocorticoids
- sympathomimetics
18
Q
continuous BP ↑ →
A
medial hyperplasia (thickening) of arterioles
19
Q
↑ thickening of arterioles d/t BP →
A
↓ perfusion → end organ damage (heart, kidneys, brain)
20
Q
damage from HTN →
A
- MI
- CVA
- PVD
- RF
21
Q
MI
A
myocardial infarction
22
Q
CVA
A
cerebrovascular accident
23
Q
PVD
A
peripheral vascular dz
24
Q
RF
A
renal failure
25
foods to improve HTN
* veggies
* fruits
* whole grains
* ↓ fat dairy products
* poultry
* fish
* legumes
* non-tropical oils
* nuts
26
foods to limit to improve HTN
* sweets
* sugary beverages
* red meat
* dietary Na+
27
exercise to improve HTN
40 min 3-4x/wk
28
Na+ restriction to improve HTN
* 2400 mg/day
* preferred: 1500 mg/day
29
medications for HTN
* diuretics
* BBs
* CCBs
* ACE inhibitors
* ARBs
30
CCB
Ca channel blocker
31
BB
beta blocker
32
ARB
angiotensin receptor blocker
33
ACE inhibitor
angiotensin-converting enzyme inhibitor
34
HTN urgencies
* can be managed outpatient
* managed w/ PO meds
* can be acute or chronic
35
HTN emergencies
* conditions w/ Sx of end organ damage
* acute evolving Sx
* expect ICU admission
* IV meds to manage at first
36
medical emergencies that can be caused by HTN
* acute CVA
* AKF/AKI
* CP, MI, ACS
37
ACS
acute cardiac syndrome
38
ARF
acute renal failure
39
ARI
acute renal injury
40
progression of CHD to HF
CAD → angina → MI → HF
41
stable angina characteristics
* predictable
* \< 15 min
* relief: rest, TNG
42
unstable angina characteristics
* unpredictable
* \> 15 min
* ↑ in occurence
* No relief with rest, TNG
43
Sx of CAD
almost always **none**
44
MI characteristics
* \> 30 min
* ↑ cardiac enzymes
* requires immediate reperfusion therapy
45
types of MI
* NSTEMI
* STEMI
46
routine labs for suspected cardiac dz
* enzymes
* myoglobin
* CK-MB
* Troponin I or T
* lipids
* TC
* HDL
* LDL
* triglycerides
47
meds for long-term MI Tx
* ASA
* BB
* Ace inhibitors
* ARBs
48
lifestyle/education for long-term MI Tx
* ↑ activity
* no nicotine
* monitoring + Tx for
* lipids
* BP
* diet: ↓ fat and Na+
49
HF long-term Tx meds
* diuretics
* antihypertensives
* BBs
* ACE inhibitors
* ARBs
* CCBs
* possibly digoxin
* anticoags
50
extra lab for HF
BNP
51
BNP
B-type natriuretic peptide
52
lifestyle/education for HF long-term Tx
* everything for MI
* + Report **SOB**
* + Daily wt: report wt increase **\> 3 lbs/24 hrs**
* – lipid monitoring + Tx, unless indicated
53
arteriosclerosis
thickening/hardening of arterial walls
54
atherosclerosis
* type of arteriosclerosis involving plaque formation on vessel walls
* obstructs normal blood flow
* stable or unstable
55
stable atherosclerosis
collagen ↓ likelihood of rupture
56
unstable atherosclerosis
rupture can cause more damage than in stable plaque rupture
57
atherosclerosis modifiable risk factors
* dyslipidemia
* lifestyle
* nicotine
* obesity
* poor diet
* inactivity
* stress
58
nonmodifiable risk factors for atherosclerosis
* genetic predisposition
* ethnicity
* African-American
* Hispanic
59
assessment for atherosclerosis
* CV assessment
* echo/doppler flow studies
* labs
60
CV assessment for atherosclerosis
* NVD
* extra heart sounds
* peripheral pulses
61
lab values in atherosclerosis
* ↓ HDL-C
* ↑ LDL-C
* ↑ triglycerides
62
interventions for CAD/atherosclerosis
* change modifiable risk factors
* lipid-lowering agents
63
groups for whom lipid-lowering meds are unsafe
* liver
* active dz
* Hx of dz
* unexplained ↑ LFTs
* reproductive
* current/possible PG
* lactation
* renal impairment
* ETOH abuse
* meds
* digoxin
* warfarin
64
PVD
* peripheral vascular dz
* umbrella term for
* peripheral artery dz
* peripheral venous dz (also PVD)
65
PAD
peripheral artery dz
66
peripheral artery dz incidence
* most common type of PVD
* legs \> arms
67
etiology of PAD
* systemic atherosclerosis
* same risk factors
68
PAD characteristics
* chronic
* partial or total occlusion to affected extremities
69
inflow PAD obstruction location
* ↑ inguinal ligament
* arteries
* distal aorta
* common, internal, and external iliac arteries
70
inflow obstruction tissue damage
atypical
71
outflow obstruction location
* arteries
* femoral
* popliteal
* tibial
* ↓ superficial femoral artery
72
outflow obstruction tissue damage
typical
73
PAD stages (4)
* Stage I: asymptomatic
* Stage II: claudication
* Stage III: rest pain
* Stage IV: gangrene/necrosis
74
inflow obstruction pain location
* back
* buttocks
* thighs
75
severity of inflow obstruction pain
* mild: a couple of blocks
* moderate: 1-2 blocks
* severe: \< 1 blocks, or at rest
76
outflow obstruction pain description
burning, cramping
77
outflow obstruction pain location
* feet
* toes
* ankles
* calves
78
outflow obstruction pain relief
dangling feet off furniture
79
outflow obstruction pain severity
* mild: ~ 5 blocks
* moderate: ~ 2 blocks + maybe intermittent at rest
* severe:
80
PAD findings are dependent on the _____ of the dz.
severity
81
PAD assessment: inspection
* hair loss on lower leg, foot
* skin
* dry, scaly, dusky, pale, mottled
* pallor w/ elevation
* severe dz: cold, cyanotic, darkened
* darker-skinned pts: assess palms, soles
* thickened toenails
82
The _____ \_\_\_\_\_ pulse is best indicator of PAD.
posterior tibial
83
PAD ulcer assessment
* typically on or between toes, on foot
* appearance
* round w/ well-defined border
* prolonged occlusion: gangrenous
84
diagnostics for PAD
* MRA
* CTA
* doppler
* exercise tolerance
* plethysmography
85
MRA
magnetic resonance angiography
86
CTA
computed tomography angiography
87
doppler flow studies for PAD
* assess segmental systolic BP
* location: thigh, calf, ankle
* values
* normal: \> brachial
* PAD: \< brachial
88
exercise tolerance test for PAD
* chemical or treadmill
* get resting pulse folume
* induce Sx, repeat pulse volume
* diagnostic
* ↓ ankle pressure (40-60 mm Hg)
* delayed return to normal \> 10 min
89
plethysmography
* waveform tracing of blood flow
* flattened waves = occlusion
90
inflow obstruction diagnostics
* thigh-level BP \< brachial
* indicates severity
* mild: 10-30 mm Hg difference
* severe: 40-50+ mm Hg difference
91
outflow obstruction diagnostics
* diagnostic: ABI \< 0.90 in either leg
* normal: ankle pressure ≥ brachial pressure
92
ABI
ankle-brachial index
93
ABI formula
ankle BP ÷ brachial BP = ABI
94
PAD nonsurgical management
* exercise: promotes development of collateral circulation
* positioning: controversial
* promoting vasodilation
* preventing vasoconstriction
95
exercise guidelines for PAD management
* gradually ↑ walking
* walk until claudication, rest, walk farther
* ↑ in amount of walking over time
* not for
* venous ulcers
* severe rest pain
* gangrene
96
guidelines on positioning for PAD
* extremities NOT above heart
* hang feet or sit upright
* don't cross legs
* no restrictive clothing
97
promoting vasodilation for PAD management
* encourage warmth w/ socks, shoes, covering
* avoid heating pads d/t ↓ sensation
98
preventing vasoconstriction for PAD management
* avoid
* cold/exposure
* emotional stress
* caffeine
* nicotine
99
PAD meds
* hemorheologic agents
* antiplatelets
* antihypertensives (careful w/ BBs)
* lipid-lowering agents
100
antiplatelets for PAD Tx
* ASA
* clopidogrel
101
hemorheologic agent action
↓ blood viscosity
102
less invasive Tx for PAD
* percutaneous vascular intervention
* artherectomy
103
percutaneous vascular intervention
* arterial entrance through groin
* balloon catheter inserted, stents placed
* common or external iliac arteries typical
104
artherectomy
* device scrapes walls of vessel to remove plaque
* used in popliteal artery or ↓
105
PAD surgical management
* arterial revascularization
* bypass occluded area w/ autografted vessel
106
indications for arterial revascularization
* severe rest pain
* claudication
* interference w/ life
107
veins used in arterial revascularization
* preferred: saphenous vein (if not needed for CAD bypass)
* alternates: cephalic or basilic vein
* synthetic material
108
inflow obstruction surgery
* bypasses occlusion above superficial femoral arteries
* indicated for
* aortoiliac
* aortofemoral
* axillofemoral
* less chance of reocclusion or post-op ischemia
109
outflow obstruction surgery
* bypass at or blow SFAs
* indicated for
* femoropopliteal
* femorotibial
* less successful in relieving pain
* higher chance of reocclusion
110
pre-op PAD care
* baseline vascular assessment data
* IV access
* prophylaxis abx
111
post-op PAD care
* incentive spirometry
* vascular assessments
* X marks the spot
* doppler pulses
* BP monitoring
* NPO
* limited ROM
112
PAD graft occlusion
* post-op emergency
* severe, continuous, aching pain
* thorough pain assessment
* extremity appearance (compare bilat.)
* possible Tx
* thrombectomy
* tPA, other antiplatelets
* watch for infection
113
home management of PAD
* promote vasodilation
* ID S/Sx of infection
* home health, case manager?
* nicotine cessation
* ↓ dietary fat intake
* Rx tasks
* exercise
* meds
* etc.
* proper foot care
114
acute PAD
* S/Sx
* sudden onset
* likely embolus, more common in LE
* pain even at rest
* cool, mottled, cold, pulseless
* untreated: necrosis or gangrene
* Hx: often pts w/ recent MI, a-fib
115
care of acute PAD
* assess 6 Ps
* maybe thrombectomy/embolectomy
* tPA
* risk for reocclusion
116
types of peripheral venous disease
* venous thromboembolism
* venous insufficiency
* varicose veins
117
function of veins
carry deoxygenated blood back to heart
118
structures that assist w/ venous function
* valves
* skeletal muscle
119
types of venous thromboembolism
* PE
* DVT
120
PE
pulmonary embolism
121
DVT
deep vein thrombosis
122
VTE
venous thromboembolism
123
defective venous valves →
* venous insufficiency
* varicose veins
124
Virchow's triad
* endothelial injury
* venous stasis
* hypercoagulability
125
types of thrombus
* phlebothrombosis
* thrombophlebitis
* deep vein thrombophlebitis
126
phlebothrombosis
thrombus w/out inflammation
127
thrombophlebitis
thrombus w/ inflammation
128
deep vein thrombophlebitis
* thrombosis: forms in deep vein
* thromboembolism: breaks off and travels to deep vein
* thrombophlebitis: thrombosis w/ inflammation
129
VTE etiology
* Virchow's triad
* surgery
* medical conditions
* immobility
* IV placement
130
DVT signs
* localized tenderness along deep venous system
* unilateral
* swelling of entire leg
* calf swelling \> 3 cm
* pitting edema
* dilated superficial veins
* previous DVT
131
VTE risk factors
* Virchow's triad
* hip surgery
* TKA
* HF
* immobility
* PG
* oral contraceptives
* active CA
132
DVT diagnostics
* imaging
* duplex US
* doppler flow study
* MRI
* lab: D-dimer
133
D-dimer
blood test to detect product of clot breakdown
134
nursing interventions for existing DVT
* prevent complications
* PE
* venous insufficiency
* post-thrombotic syndrome
* education
* current DVT
* prevention of future DVTs
135
DVT prevention nursing interventions
* ambulation
* hydration
* compression
* stockings
* SCDs
* anticoagulants
* elevation
136
compressing stockings guidelines
* must wear for extended period
* measure and use correct size, adjusting for wt changes
* DO NOT massage extremity
* assess
* skin
* 6 Ps
* cap refill
137
heparin therapy admin for DVT
* IV infusion
* prevents new clots
* body breaks down existing clot
* check labs before admin
138
labs for heparin therapy
* aPTT: 1.5-2x normal
* PT/INR
* CBC
* UA
* FOBT
* Cr
139
safety measures for heparin therapy
* reliable IV pump
* assessment
* reach/maintain therapeutic aPTT
* watch for S/Sx of
* bleeding
* HIT
* **antidote: protamine**
140
S/Sx of bleeding to watch for during heparin therapy
* bruising
* petechiae
* melena
* hematemesis
* hematoma
141
therapeutic aPTT for heparin therapy
* 1.5-2x normal
* **notify provider if \> 70 sec**
142
HIT
heparin-induced thrombocytopenia
143
heparin-induced thrombocytopenia
* immune rxn to heparin → widespread clotting
* life-threatening
* occurs w/ prolonged therapy
144
prevention of HIT
* LMWH
* more commonly used
* ↓ complications
145
warfarin therapy for DVT
* may be added to regimen for home use
* inhibits synthesis of clotting factors in liver
* pt education
* will need regular labs
* watch for S/Sx of bleeding
* prevent injuries
* keep antidote on hand
* **antidote: vitamin K**
146
PT/INR values for warfarin therapy after DVT
* INR of 1.5-2 for prevention
* 3.5-4 for pts w/
* CV conditions
* PE
* risk for CVA
147
inferior vena cava filtration nursing care
monitor for bleeding or infection at insertion site
148
DVT self-management education
* self-injection of LMWH
* med compliance
* follow-up and monitoring needs
* dietary strategies
* bleeding, bruising, and how to avoid
* drug interactions
* keep antidote on hand
149
venous insufficiency patho
* prolonged venous HTN
* stretches veins
* damages valves
* → blood backup, stasis
* → ↓ perfusion
* → edema
* → ulcers
* → cellulitis
150
venous insufficiency risk factors
* sitting or standing for long periods
* obesity
* PG
* thrombophlebitis
151
venous insufficiency interventions
* promote venous return
* ↓ edema
* heal ulcers
* treat or prevent infection
* prevent ulcer recurrence
152
venous ulcer care
* topical Tx
* hydrocolloid dressing
* artificial or cultured epithelial autografts
* unna boot
* chemical debridement
* surgical: debridement; *other surgeries not effective*
153
varicose vein patho
* distended, tortuous veins
* weakened vessel walls dilate
* valves become incompetent
* advanced dz →
* insufficiency
* edema
* ulcers
154
varicose vein risk factors
* female
* \> 30 yo + prolonged standing
* systemic dz
* HD
* DM
* HTN
* obesity
* PG
* family Hx
155
types of aneurysms
* fusiform
* saccular
* true
* false
* dissecting
156
aneurysm
permanent, localized dilation of artery ≥ 2x original size
157
aneurysm patho
* tunica media weakens, stretching intima and externa
* continued stretching + ↑ tension →
* ↑ size of aneurysm
* risk for rupture
* + HTN → ↑
* rate of enlargement
* risk for rupture
158
fusiform aneurysm
entire artery circumference affected
159
saccular aneurysm
outpouching affecting only distinct area
160
true aneurysm
arterial wall weakened by congenital or acquired causes
161
false aneurysm
vessel injury or trauma to all vessel wall layers
162
dissecting aneurysm
formed when blood accumulates in artery walls
163
typical aneurysm locations
* most common: AAA
* less common: TAA
164
AAA
abd aortic aneurysm
165
abd aortic aneurysm
* most common aneurysm location
* rarely symptomatic until emergent
* often between bifurcation and renal arteries
166
TAA
thoracic aortic aneurysm
167
thoracic aortic aneurysm
* less common than AAA
* often missed or misdiagnosed
* typically in ascending, descending, or transverse aorta
168
aneurysm risk factors
* nonmodifiable
* age
* gender
* family Hx
* modifiable
* atherosclerosis
* HTN
* hyperlipidemia
* nicotine
169
AAA assessment
* pain
* sites: abd, back, flank
* steady, gnawing
* duration: hrs or days
* pulsation in upper abd
* DO NOT PALPATE
* auscultate for aortic bruits
170
TAA assessment
* back pain
* compression of aorta
* SOB
* hoarseness
* difficulty swallowing
* possible visible mass above suprasternal notch
171
aneurysm rupture
* EMERGENT
* critically ill pts
* TAA: sudden, excruciating chest or back pain
* loss of pulses distally
* retroperitoneal: flank hematoma
* peritoneal: distended abd
* risk for hypovolemic shock
* hypotension
* diaphoresis
* ↓ LOC
* oliguria
172
nonsurgical aneurysm management
* antihypertensives
* maintain BP
* ↓ rate of enlargement, risk for early rupture
* if small, asymptomatic: frequent CT or US
* pts need to follow up as scheduled
* will be treated nonsurgically as long as possible
173
surgical management of aneurysm
* rupture = surgical emergency
* Tx of choice
* endovascular stent grafts
* percutaneous insertion
174
aneurysm post-op care
* close monitoring
* for graft occlusion
* VS
* pulses distal to graft
* surgical site
* pain level
* HTN meds
* HOB \< 45˚ to prevent graft flexion
175
post-op aneurysm home care
* BSC
* limited activity
* no heavy lifting: \< 15 lbs. x 6-12 wks
* compliance w/ follow-ups
* HTN meds
* **S/Sx of rupture**
176
assessment of popliteal or femoral aneurysm
* may be associated w/ aneurysm elsewhere
* pulsating mass at site
* DO NOT PALPATE
* S/Sx
* ischemia
* ↓ pulses
* cool or cold skin
* pain
177
Tx of popliteal or femoral aneurysm
* femoral: often uses autogenous saphenous vein graft w/ aneurysm removal
* popliteal: usually bypass
178
post-op care of popliteal or femoral aneurysm repair
* pulses below site as ordered: X + doppler
* monitor
* 6 Ps
* VS
* hypotension: clot
* HTN: bleeding
* pain level: sudden change = occlusion
* limit bending extremity
179
aortic dissection
* uncommon
* life-threatening
* patho: sudden tear in intima maybe d/t degeneration of media
* locations
* more common: ascending and descending thoracic
* any major artery from aorta
180
aortic dissection assessment
* pain
* 10/10
* "ripping"
* "tearing"
* diaphoresis
* N/V
* apprehension
* faintness
* BP
* imminent: HTN
* rupture/tamponade: hypotension
* weak/absent distal pulses
181
aortic dissection interventions
* **large-bore IVs x2**
* ↓ BP: BB + nicardipine
* IV fluids
* foley to monitor renal fxn
* long-term: SBP ≤ 130-140
182
CV conditions ASA is used for
* MI
* long-term Tx
* CP emergency Tx (MONA)
* PAD maintenance
183
CV conditions requiring heparin therapy
* thrombus formation
* high risk for thrombus formation
184
when is warfarin used?
home therapy for those at high risk of thromboembolic d/o or with a history of such d/o
