Vascular

Question 1

HTN classification

Answer 1

normal: <120 / <80
prehypertension: 120-139 / 80-89
HTN stage I: 140-159 / 90-99
HTN stage II: ≥160 / ≥100

Question 2

JCN 8 HTN treatment goals

Answer 2

if 60 or older: initiate treatment at ≥150 / ≥90

if younger than 60 or has DM or CKD: initiate treatment at ≥140 / ≥90

Question 3

effects of uncontrolled HTN

Answer 3

• retinopathy
• heart: ventricular hypertrophy, MI, CAD, HF
• renal failure
• PVD
• brain: hemorrhage, stroke, dementia

Question 4

HTN teaching

Answer 4

• sodium intake less than 2000 mg/day
• lifestyle modifications
• DASH diet - high in potassium
• exercise, weight loss
• smoking cessation

Question 5

PAD patho

Answer 5

• progressive thickening and degeneration of arteries with narrow lumens and fatty deposits
• leading cause: atherosclerosis
• other causes: smoking, hyperlipidemia, DM, HTN, obesity

Question 6

PAD symptoms (7)

Answer 6

• intermittent claudication, later progresses to rest pain
• decreased/absent peripheral pulses
• loss of hair on legs, feet
• ulceration, gangrene of toes/feet
• thick, brittle nails
• dependent rubor, pallor on elevation
• cool, thin, shiny, dry skin

Question 7

6 Ps of PAD

Answer 7

pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia

Question 8

PAD stages

Answer 8

1 - asymptomatic
2 - intermittent claudication
3 - rest pain
4 - necrosis, gangrene, ulcers

Question 9

ankle-brachial index (ABI)

Answer 9

• ratio of ankle SBP to brachial SBP

- objective indicator of PAD

Question 10

ABI range

Answer 10

1 = normal
0.5-0.95 = mild to moderate insufficiency
< 0.5 = ischemic rest pain
≤ 0.25 = severe ischemia, tissue loss

Question 11

meds fo PAD (4)

Answer 11

• clopidogrel (Plavix)
• pentoxifylline (Trental)
• cilostazol (Pletal)
• ASA

Question 12

surgical interventions for PAD

Answer 12

• percutaneous transluminal cylindrical angioplasty (PTCA)
• arterial bypass surgery - ex. fem-pop bypass
• endarterectomy

Question 13

post-op interventions for arterial bypass surgery

Answer 13

• check color, temp, pulses, pain intensity
• check BP
• avoid bending, sitting for long periods
• check S/S of infection

Question 14

PVD patho

Answer 14

• incompetent valves of deep veins; venous obstruction and insufficiency
• usually caused by uncontrolled HTN

Question 15

PVD interventions

Answer 15

• elevate extremity
• extrinsic compression
• moist dressing environment for ulcers
• observe for infection
• good nutrition